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Two-Year Outcomes of the Proximal Hamstring Avulsion Rehabilitation Regimes: Longitudinal Versus Accelerated Protocol
Jay R Ebert1,2,3,4, Peter K Edwards3,4,5, Steven Cecchi6
1School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia.
The American Journal of Sports Medicine
|June 22, 2026
Summary
Accelerated rehabilitation (AR) after proximal hamstring repair showed comparable outcomes to conservative (CR) rehabilitation, with similar strength, function, and reinjury rates. Both pathways led to improved patient-reported outcomes and function over two years.
Area of Science:
- Orthopedic surgery
- Sports medicine
- Rehabilitation science
Background:
- Proximal hamstring tendon repair protocols vary significantly, especially regarding bracing and weight-bearing restrictions.
- Acute avulsion injuries involving multiple tendons require standardized yet adaptable rehabilitation strategies.
Purpose of the Study:
- To compare clinical outcomes, strength recovery, functional symmetry, and complications between conservative (CR) and accelerated (AR) rehabilitation pathways following proximal hamstring repair for acute multi-tendon avulsions.
- To evaluate the long-term (2-year) efficacy of different postoperative rehabilitation approaches.
Main Methods:
- A prospective randomized controlled trial (RCT) with Level 1 evidence.
- Patients were assigned to either a CR group (6 weeks bracing, restricted weight-bearing) or an AR group (no bracing, full weight-bearing as tolerated).
- Outcomes assessed included patient-reported outcome measures (PROMs), isokinetic strength (PKFT, PKET), and single-leg horizontal hop test for distance (SLHD), with a primary focus on 6-month limb symmetry index (LSI) for PKFT.
Main Results:
- The AR group showed significantly better Short-Form Health Survey physical scores at 3 months and reduced hamstring pain at 3 and 12 months.
- All patients demonstrated significant improvements in strength (PKFT, PKET) and function (SLHD) over time, with comparable LSIs between groups.
- A 7% reinjury rate (4 patients) was observed across both groups, with no significant difference in outcomes related to hops or strength.
Conclusions:
- Proximal hamstring repair for acute multi-tendon avulsions results in improved PROMs, strength, and function with a low reinjury rate over two years.
- The AR pathway, allowing full weight-bearing without bracing, yielded comparable subjective, functional, and reinjury outcomes to the CR pathway.
- The study was underpowered to definitively compare reinjury risk between the two rehabilitation protocols.
