Functional impairment after successful surgical reconstruction for proximal hamstring avulsion

Surgical refixation procedures after hamstring avulsion injuries show satisfying to excellent outcome results. However, for post-operative evaluation so far, used outcome scores were partially not injury-specific, heterogeneous, difficult to compare, and possibly overestimated due to ceiling effects. A new injury-specific assessment tool has recently been published, potentially depicting more realistic outcome results. Thus, the aim of our study was to evaluate patients after hamstring refixation surgery using previously utilized as well as the new Perth hamstring assessment tool (PHAT).

A series of operated hamstring injuries were retrospectively evaluated using the PHAT as well as the widespread, customized Lower Extremity Functional Scale (C-LEFS) and the customized Marx score (C-Marx). Scores as well as potential ceiling effects were evaluated individually, and compared and correlated to each other.

Sixty-four patients were enrolled into the survey. Forty-nine questionnaires (76%) could be evaluated. The mean total PHAT score (0-100) after 28 months (SD ± 17.0) was 74.1 (SD ± 22.5) points. Mean total C-LEFS (0-80) revealed 61.4 (SD ± 18.1) points, and the mean total C-Marx score (20) was 19.4 (SD ± 1.6) points. Pearson's correlation between the individual questionnaires was high between the PHAT and the C-LEFS (r = 0.81) and low between the PHAT and C-Marx (r = 0.52) and between C-LEFS and C-Marx (r = 0.48).

The presented study confirms good subjective functional outcomes after surgical intervention of hamstring avulsions in all scores. Nevertheless, using the PHAT, residual complaints are more common than often described in previous studies interpreting "conventional" scores. For future decision and patient guidance, more studies using injury-specific assessments such as the PHAT in combination with objective measurements are eligible.