Functional Outcomes of Proximal Hamstring Tendon Repair in Patients Over 40 Treated Without Postoperative Bracing

Degenerative tendon changes are common as people age, which can increase the likelihood of tendinous injuries. The outcomes of repairing hamstring tendon avulsions in patients >40 years after a rehabilitation protocol without postoperative bracing are relatively unknown.

To assess the functional outcomes of patients >40 years and determine the rerupture rate after surgical repair of complete proximal hamstring tendon avulsions while following a nonbracing rehabilitation protocol.

Case series; Level of evidence, 4.

A total of 27 patients >40 years with acute, complete proximal hamstring avulsions underwent surgical repair between 2012 and 2022 and completed follow-up assessments. Postoperative patient-reported outcome measures (PROMs) included the Single Assessment Numeric Evaluation (SANE), Physical (PCS) and Mental (MCS) Short Form 12 (SF-12), Marx Activity Rating Scale (Marx), Lower Extremity Functional Score (LEFS), Perth Hamstring Assessment Tool (PHAT), patient satisfaction (0-10 scale), and return to sports (RTS). Surgical repair integrity was assessed with physical and ultrasound examinations.

A total of 27 patients-including 10 men and 17 women-and 28 hips-including 10 right-leg and 18 left-leg hamstring avulsions-were included in this study. The mean age was 55.9 ± 8.3 years, and the mean body mass index was 27.1 ± 6.5 kg/m² at the time of surgery. All 28 injuries were complete avulsions involving 3 hamstring tendons. The mean time from injury to surgery was 17.9 ± 12.4 days; 25 avulsions were repaired early (time to surgery <6 weeks), and 3 hamstrings were repaired delayed (6 to 8 weeks). All 28 avulsions were retracted at a mean distance of 4.9 ± 2.9 cm from the ischial tuberosity. The mean follow-up time was 67 ± 28.5 months. The mean follow-up PROMs included a SANE of 85.9 ± 18.1, SF-12 PCS of 49 ± 8.3, and SF-12 MCS of 54.7 ± 7.1, Marx of 6.3 ± 5.6, LEFS of 69.9 ± 12.7 (completed for 27 hips), PHAT of 82.1 ± 16.3 (completed for 26 hips), patient satisfaction of 9.1 ± 2, and 22 patients returned to sports (78.6%). At the last follow-up, all tendon repairs appeared intact and reinserted at the ischial tuberosity after ultrasound and physical examinations, and there were no signs of rerupture.

Surgical repair of complete proximal hamstring tendon avulsions with a nonbracing rehabilitation protocol for patients >40 years demonstrated intact repairs with no reruptures. Some patients reported pain during follow-up functional testing, but the overall results highlighted positive functional and patient-reported outcomes, high levels of satisfaction, and a high RTS rate.