Mid-term Functional Outcome and Return to Sports after Proximal Hamstring Tendon Repair

Abstract

Proximal hamstring tendon ruptures are commonly associated with a significant loss of function, and operative treatment is recommended in active patients. The objective was to evaluate objective/subjective functional results and return to sports following proximal hamstring tendon repair in the mid-term follow-up. 16 repairs of proximal hamstring ruptures were performed in 15 patients (9 males, 6 females). The average age at the time of injury was 47 years (range, 21–66). All patients were clinically examined at a mean follow-up of 56 months (range, 24–112 months). Validated patient-oriented assessment scores focussing on sports activity including the Lysholm Score, Tegner Activity Score, UCLA Activity Score, adapted WOMAC Score, and the VAS were evaluated as well as the return to sports. Isokinetic strength of both legs was tested using a rotational dynamometer. The Lysholm, Tegner, UCLA Activity Score and the adapted WOMAC demonstrated predominantly a return to a preinjury activity level at follow-up. Functional measurements of the operated leg showed similar results to the uninjured leg in knee extension and flexion strength (p>0.094). In return to sports, no signficant (p>0.05) differences concerning types or frequency were noted. The surgical repair of proximal hamstring tendon ruptures leads to constantly good functional results in the mid-term follow-up, where patients demonstrate similar isokinetic results in the healthy leg.

Key words

hamstring - tendon rupture - outcome - return to sports - isokinetic testing

• References

• 1 Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C. Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am 1984; 66: 228-241
• 2 Anzel J, Covey K, Weiner A. Disruption of muscles and tendons. An analysis of 1014 cases. Surgery 1959; 45: 406-414
• 3 Arnason A, Sigurdsson S, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Risk factors for injuries in football. Am J Sports Med 2004; 32: 5-16
• 4 Blasier RB, Morawa LG. Complete rupture of the hamstring origin from a water skiing injury. Am J Sports Med 1990; 18: 435-437
• 5 Brucker PU, Imhoff AB. Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 2005; 13: 411-418
• 6 Carmichael J, Packham I, Trikha SP, Wood DG. Avulsion of the proximal hamstring origin. Surgical technique. J Bone Joint Surg Am 2009; 91 (Suppl. 02) 249-256
• 7 Chahal J, Bush-Joseph CA, Chow A, Zelazny A, Mather RC, Lin E, Gupta D, Verma NN. Clinical and magnetic resonance imaging outcomes after surgical repair of complete proximal hamstring ruptures: does the tendon heal?. Am J Sports Med 2012; 40: 2325-2330
• 8 Chakravarthy J, Ramisetty N, Pimpalnerkar A, Mohtadi N. Surgical repair of complete proximal hamstring tendon ruptures in water skiers and bull riders: a report of four cases and review of the literature. Br J Sports Med 2005; 39: 569-572
• 9 Clanton TO, Coupe KJ. Hamstring strains in athlete: diagnosis and treatment. J Am Acad Orthop Surg 1998; 6: 237-248
• 10 Cross M, Vandersluis R, Wood DG. Surgical repair of chronic complete hamstring tendon rupture in the adult patient. Am J Sports Med 1998; 26: 785-788
• 11 DeSmet A, Best TM. MR imaging of the distribution and location of acute hamstring injuries in athletes. Am J Roentgenol 2000; 174: 393-399
• 12 Feucht MJ, Plath JE, Seppel G, Hinterwimmer S, Imhoff AB, Brucker PU. Gross anatomical and dimensional characteristics of the proximal hamstring origin. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2576-2582
• 13 Floor S, van der Veen AH, Devilee RJ. Two patients with a complete proximal rupture of the hamstring. Arch Orthop Trauma Surg 2010; 130: 523-526
• 14 Folsom GJ, Larson CM. Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 2008; 36: 104-109
• 15 Gidwani S, Bircher M. Avulsion injuries of the hamstring origin – a series of 12 patients and management algorithm. Ann R Coll Surg Engl 2004; 89: 394-399
• 16 Gift AG. Visual analogue scales: measurement of subjective phenomena. Nurs Res 1989; 38: 286-288
• 17 Harriss DJ, Atkinson G. Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med 2015; 36: 1121-1124
• 18 Harris JD, Griesser MJ, Best TM, Ellis TJ. Treatment of proximal hamstring ruptures – a sytematic review. Int J Sports Med 2011; 32: 490-495
• 19 Hofmann KJ, Paggi A, Connors D, Miller SL. Complete avulsion of the proximal hamstring insertion: functional outcomes after nonsurgical treatment. J Bone Joint Surg Am 2014; 96: 1022-1025
• 20 Klingele K, Sallay P. Surgical repair of complete proximal hamstring tendon rupture. Am J Sports Med 2002; 30: 742-747
• 21 Konan S, Haddad F. Successful return to high level sports following early surgical repair of complete tears of the proximal hamstring tendons. Int Orthop 2010; 34: 119-123
• 22 Kujala UM, Orava S, Järvinen M. Hamstring injuries: current trends in treatments and prevention. Sports Med 1997; 23: 397-404
• 23 Lempainen L, Banke IJ, Johansson K, Brucker PU, Sarimo J, Orava S, Imhoff AB. Clinical principles in the management of hamstring injuries. Knee Surg Sports Traumatol, Arthrosc 2015; 23: 2449-2456
• 24 Lempainen L, Sarimo J, Heikkila J, Mattila K, Orava S. Surgical treatment of partial tears of the proximal origin of the hamstring muscles. Br J Sports Med 2006; 40: 688-691
• 25 Lempainen L, Sarimo J, Orava S. Recurrent and chronic complete ruptures of the proximal origin of the hamstring muscles repaired with fascia lata autograft augmentation. Arthroscopy 2007; 23: 441-445
• 26 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10: 150-154
• 27 Miller SL, Gill J, Webb GR. The proximal origin of the hamstrings and surrounding anatomy encountered during repair. A cadaveric study. J Bone Joint Surg Am 2007; 89: 44-48
• 28 Naal FD, Fischer M, Preuss A, Goldhahn J, von Knoch F, Preiss S, Munzinger U, Drobny T. Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med 2007; 35: 1688-1695
• 29 O’Sullivan K, Murray E, Sainsbury D. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskelet Disord 2009; 10: 37
• 30 Orava S, Kujala UM. Rupture of the ischial origin of the hamstring muscles. Am J Sports Med 1995; 23: 702-705
• 31 Sallay PI, Ballard G, Hamersly S, Schrader M. Subjective and functional outcomes following surgical repair of complete ruptures of the proximal hamstring complex. Orthopedics 2008; 31: 1092
• 32 Sallay PI, Friedman R, Coogan P, Garret WE. Hamstring muscle injuries among water skiers. Am J Sports Med 1996; 24: 130-136
• 33 Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 2008; 36: 1110-1115
• 34 Skaara HE, Moksnes H, Frihagen F, Stuge B. Self-reported and performance-based functional outcomes after surgical repair of proximal hamstring avulsions. Am J Sports Med 2013; 41: 2577-2584
• 35 Slavotinek J, Verral G, Fon G. Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition. Am J Roentgenol 2002; 179: 1621-1628
• 36 Stucki G, Meier D, Stucki S, Michel BA, Tyndall AG, Dick W, Theiler R. Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index. Z Rheumatol 1996; 55: 40-49
• 37 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; 198: 43-49
• 38 van der Made AD, Reurink G, Gouttebarge V, Tol JL, Kerkhoffs GM. Outcome after surgical repair of proximal hamstring avulsions: a systematic review. Am J Sports Med 2015; 43: 2841-2851