A Comparison of Non-Operative and Operative Treatment of Complete Proximal Hamstring Ruptures

OBJECTIVES: Early repair of acute proximal hamstring ruptures provides better clinical results than delayed repairs. However, it is unclear how the non-operative treatment compares to the operative treatment of these injuries. We compare the clinical results of non-operative and operative treatment of acute proximal hamstring ruptures. METHODS: A retrospective case-control study of patients with a complete, retracted, proximal hamstring rupture was performed from 2007 to 2013. All patients were given the option of a proximal hamstring repair at the time of initial evaluation. Patients at least 12 months from the time of surgery or injury were included for evaluation. Acute proximal hamstring injuries were included; and partial proximal hamstring tears and chronic injuries repaired were excluded. The primary outcome measure was the lower extremity functional score (LEFS). Secondary outcome measures included the SF-12 physical and mental component scores, a single leg hop (average of three jumps), the patient's perception of strength (0-100%), and ability to return to activity. RESULTS: A total of 25 patients were enrolled. The 14 patients treated surgically sustained injuries at 46.98 ± 9.73 years of age, were repaired at 28.14 ± 14.06 days, and evaluated at 50.62 ± 10.11 years of age. The 11 patients treated non-operatively sustained injuries at 55.6 ± 10.45 years of age (p = 0.05), attempted therapy an average of 4.6 ± 3.22 months, and were evaluated at 58.4 ± 8.31 years of age (p= 0.06). The LEFS for the surgical and non-surgical groups was 74.71 ± 5.38 and 68.5 ± 7.92 (p = 0.04), respectively. SF-12 mental and physical components scores were similar between groups. The average single leg hop of the injured extremity in the surgical and non-surgical groups was 119.1 ± 27.68 cm and 56.1 ± 31.2 cm (p = 0.0001), respectively. When compared to the uninjured leg, the average single leg hop in the injured leg was 5.1 ± 12.1 cm and 1.2 ± 17.2 cm (p = 0.51) shorter in both the surgical and non-surgical groups, respectively. The LEFS had a weak correlation with the average single leg hop and age in the surgical (R2 = 0.2478 and 0.0664, respectively) and non-surgical (R2 = 0.0023 and 0.052, respectively) groups. The patient's perception of strength was similar between the surgical and non-surgical groups (86.07 ± 12.12% and 83.6 ± 14.15%, p = 0.64). All patients in the operative group were able to return to pre-injury activities whereas three were unable to in the non-operative group (chi-square stat = 4.33, p = 0.03). CONCLUSION: Patients with acute proximal hamstring ruptures treated surgically have better lower extremity function and a higher likelihood of returning to pre-injury activities than patients treated non-surgically.