Functional Outcomes Following Surgical Repair of Acute and Chronic Ruptures of the Proximal Hamstring Tendons

OBJECTIVES: Surgical repair of complete ruptures of the proximal hamstring tendons have shown improved function compared with non-operative treatment, however, results have been less favorable in the setting of a chronic tendon rupture. We previously described our surgical technique using an allograft Achilles tendon reconstruction and now report on functional outcomes of a larger patient cohort with longer follow-up and compare these with patients that underwent acute primary repair. METHODS: Between 2002 and 2011, 23 patients with chronic ruptures who had undergone reconstruction using an Achilles tendon allograft and 57 patients with acute ruptures who had undergone primary repair were contacted and asked to rate their current function from 0-100% for both activities of daily living and sports-related activities. Additionally, those with chronic ruptures were asked to rate their level of function after their injury and prior to surgery. Patients were also asked to complete the SF-12 and a Patient Satisfaction Questionnaire. RESULTS: Patients who had an Achilles reconstruction for chronic tears reported significant improvement in their function from pre-surgery to post-surgery for both activities of daily living (51% vs. 90%, p < 0.01) and sports-related activities (20% vs. 68%, p < 0.01) at an average follow-up of 46.8 months. Compared with the acute repair group (average follow-up 42.3 months) those in the chronic reconstruction group reported similar function for activities of daily living (90% vs. 92%, p = 0.484), but decreased function in sports-related activities, which approached statistical significance (68% vs. 79%, p = 0.125). A higher percentage in the acute repair group reported that their hamstring felt “normal” (83% vs. 67%, p=.013). All other quality of life and satisfaction scores were similar between groups. CONCLUSION: Both acute repair and chronic reconstruction of complete proximal hamstring tears yield favorable results for activities of daily living. With respect to sports-related activities, acute repair yields improved function. For low-demand patients or those with medical comorbidities that preclude acute surgical treatment, initial non-operative management with the option for Achilles allograft reconstruction at a later time can be expected to give approx 90% return of function for everyday activities. For patients that desire to return to sports or higher demand activities, acute repair is recommended.