Accelerated Rehabilitation Following Repair of Proximal Hamstring Avulsion: 4 Year Outcomes

OBJECTIVES: Proximal hamstring tears are relatively uncommon injuries, but can lead to persistent pain and disability. Previous literature has described avulsion of all three proximal tendons, avulsion of two tendons with retraction of over 2 cm, and tendon avulsions with failure of non-operative management as indications for operative repair. Most previous studies have utilized post-operative protocols that include some form of brace immobilisation to restrict hip flexion and knee extension and/or a limited weight-bearing period. We hypothesize that proximal hamstring repair utilizing an accelerated rehabilitation protocol that allows full weight-bearing without immobilization immediately post-operative will result in similar outcomes to published series and that better results will be noted in acute repairs (surgery within 4 weeks of injury). METHODS: Retrospective chart review identified 47 proximal hamstring tendon repairs in 43 patients performed at our institution between 2008 and 2015. Proximal hamstring tendon repair was carried out with suture anchors by a single sports medicine fellowship-trained orthopaedic surgeon. Post-operative rehabilitation included no immobilization or limited weightbearing. Patients were only instructed to avoid rapid walking for 6 weeks post-operative. Clinical history, radiographic findings, and surgical details were obtained from chart data. Patients were then contacted to by phone to assess outcomes following surgery utilizing the lower extremity functional score (LEFS), the single assessment numeric evaluation (SANE), and Marx activity scale. Complications and repair failures were also noted. Overall patient-reported scores were calculated and results of acute and chronic repairs were compared. RESULTS: Thirty-four patients who underwent a total of 38 proximal hamstring repairs (80.8%) were available for follow-up via phone interview at a mean of 4.1 ± 2.0 years following proximal hamstring repair. There were two re-tears: one rupture at 5 weeks post-op and one partial rupture at 10 weeks post-op. Overall, patients reported high satisfaction with the procedure, with a mean LEFS score of 87± 21%, a mean SANE score of 88.1 ± 11.6, and a Median Marx activity score of 5. The acute repair group was noted to have a higher mean LEFS score (93.7 ± 11.1%) than the chronic repair group (79.8 ± 28.8%), p = 0.046. The average SANE score in the acute group (91.3 ± 8.3) was also significantly higher than in the chronic group (83.8 ± 14.3), p = 0.047. The median Marx Activity scale was similar in the acute (median = 5.5) and chronic (median = 5.0) groups (p = 0.88). CONCLUSION: Proximal hamstring tendon repair followed by post-operative rehabilitation that included no immobilization or limited weight bearing resulted in patient-reported outcomes scores and repair failure risk that were similar to previously published series that utilized more limiting post-operative protocols. Better patient-reported outcomes were noted in repairs performed within 4 weeks of injury.