Excellent clinical outcome and low complication rate after proximal hamstring tendon repair at mid-term follow up

Proximal hamstring tendon avulsions lead to a significant loss of strength and a functional deficit of the respective lower limb and surgery is the recommended treatment. Only little is known about the clinical outcomes and complications when comparing acute and chronic management as well as partial and complete tears. Therefore, the purpose of this study was to investigate the clinical results and the complication rate of patients after surgical treatment of proximal hamstring tendon injuries. It was hypothesized that surgical treatment of an acute proximal hamstring avulsion would lead to a superior clinical outcome with a low complication rate and high return to sports rate compared to chronic cases and partial avulsions.

Patients who underwent proximal hamstring tendon repair between 2008 and 2015 were retrospectively evaluated with a minimum follow up of 2 years. Outcome measurements were obtained by means of Lysholm score, Harris Hip Score, Visual Analog Scale, and Tegner Activity Scale. Return to sports (RTS) rate was determined. Postoperative adverse events were recorded and complications reported. Patients' outcomes were compared between acute/chronic repair and partial/complete injury patterns.

Ninety-four of 120 (78.3%) were available for final assessment at a mean follow-up of 56.2 ± 27.2 months. Clinical outcome measures were excellent and did not differ between the treatment groups or between the different injury patterns. RTS was achieved by 86.2% of the patients and was significantly superior after acute treatment (p < 0.05). The overall complication rate was 8.5% and significantly higher in complete tears compared to partial tears and in delay compared to acute surgery (p < 0.05).

Surgical treatment of proximal hamstring tendon avulsions results in excellent clinical outcome scores and a high RTS rate. Open surgical treatment has shown to be a safe procedure with a low complication rate. Surgical timing is important, as early surgical intervention provides a higher RTS rate and a lower complication rate than delayed surgery and should therefore be preferred in clinical practice. Repair of partial and complete tears lead to similar clinical outcome, but a higher complication rate in complete avulsions.

Level IV.