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Published on: April 30, 2014
Functional outcomes and return to sport after surgical repair of complete proximal hamstring avulsions in
Jorge Isla1, Waldo Gonzalez2, Consuelo Carrasco3
1Faculty of Medicine, Clinica Alemana Santiago - Universidad del Desarrollo, Santiago de, Chile; Hospital of Salvador, Providencia, Santiago de, Chile.
Introduction/Objectives:
Proximal hamstring avulsion is an uncommon but disabling injury that may cause persistent pain, weakness, sitting intolerance, and sciatic nerve-related symptoms. Surgical repair is commonly considered in active patients with complete three-tendon avulsions or two-tendon avulsions with substantial retraction, although optimal management remains debated. This study aimed to describe functional outcomes, health-related quality of life, neurological symptoms, and return to sport after open repair of complete or retracted proximal hamstring avulsions in recreational athletes.
Methods:
A retrospective descriptive case series was conducted at a single center. Recreational athletes who underwent open proximal hamstring repair by the same surgeon between April 2022 and July 2025 were included if they had complete two-tendon avulsion with >2 cm retraction or complete three-tendon avulsion. Patients with <6 months of follow-up, low sporting demand, or incomplete records were excluded. Final follow-up outcomes included the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT), Short Form-36 Health Survey (SF-36), time to return to sport, and return to preinjury level. Normality of continuous variables was assessed using the Shapiro-Wilk test, and results were reported as mean ± standard deviation or median with interquartile range according to data distribution.
Results:
Eleven patients were included, with a mean age of 47.7 years and a mean sports participation frequency of 3.2 sessions per week. All injuries were Wood type 5, and 81.8% involved three tendons. Mean time from injury to surgery was 16.2 days, and mean clinical follow-up was 18.9 months. Preoperative sciatic symptoms were present in 36.4% of patients. Immediate postoperative numbness occurred in 54.5% and persisted at final follow-up in 36.4%. All patients returned to sport at a mean of 5.1 months; however, only 36.4% returned to their preinjury sporting level. The median LEFS was 96.3% of the maximum score, the mean PHAT score was 92.3 ± 6.5, the median Short Form-36 Physical Component Summary was 62.7, and the median Short Form-36 Mental Component Summary was 50.7.
Conclusion:
Open repair of complete or retracted proximal hamstring avulsions in active recreational athletes was associated with excellent patient-reported function and universal return to sport at mid-term follow-up. However, return to preinjury sporting level was achieved by only one-third of patients, and persistent sensory symptoms were relatively frequent. These findings support surgical repair in selected active patients while emphasizing careful preoperative counseling and larger comparative studies.
Level Of Evidence:
Level IV, Retrospective case series.
