Long-term Outcomes and Return to Sport After Surgical Repair of Proximal Hamstring Avulsions: A ≥8-Year Follow-up...

Proximal hamstring avulsion injuries (PHAIs) are debilitating injuries that can affect long-term quality of life.

To evaluate the long-term functional results of PHAI repair and determine the rate of patient satisfaction and the quality of their return to sport at the latest follow-up.

Prospective cohort study; Level of evidence, 2.

This was a prospective cohort study conducted from January 2002 to May 2015. The study targeted all patients undergoing PHAI repair during this time frame, ensuring a minimum follow-up of 8 years. The primary outcome measure used was the Parisian Hamstring Avulsion Score (PHAS). Secondary outcome measures included the University of California at Los Angeles (UCLA) activity scale score and the Tegner activity scale score. A satisfaction survey was administered, the complication rate was assessed, and both the rate and quality of return to sport were analyzed. A subanalysis comparing acute (<4 weeks) versus chronic (>4 weeks) repairs was performed.

The study involved 139 patients with a mean age of 44.4 years (SD, 11.3 years) and a mean follow-up duration of 123.4 months (SD, 30.8 months). The PHAS at the last follow-up was 87.5 (SD, 14.9). This score was significantly affected by follow-up length (ANOVA-type statistic = 65.40497; df = 4.050724; P < .0002), with post hoc analysis showing lower median scores at 2 years compared with 6 and 8 years (P = .04 and P = .001, respectively) and at 4 years compared with 6 and 8 years (P = .001 and P = .01, respectively). The UCLA activity scale score improved significantly from a preoperative mean of 3.1 (SD, 1.3) to 7.5 (SD, 2.5) at the final follow-up (P < .001). Similarly, the Tegner activity scale score increased from a mean of 1.8 (SD, 1.3) before surgery to 4.5 (SD, 2.1) at the final follow-up (P < .001). Satisfaction was reported by 87.8% of patients. Reruptures were recorded in 11 patients, accounting for 7.9% of the cases. Overall, 80% of the patients returned to the same type of sport postoperatively as before the injury, with 43.5% reaching the same preoperative level. Chronic repairs demonstrated 5.89-fold higher odds of achieving a low PHAS (OR, 5.89; 95% CI, 2.36-17.0; P < .001).

Surgical repair of PHAI is associated with improved long-term functional outcomes. The PHAS is expected to increase over time until 8 years postoperatively. Chronic repairs carry nearly 6 times higher odds of poor long-term PHAS performance compared with acute repairs.