Pre-operative activity level and a sport or recreation injury mechanism are associated with 2-year clinical outcome after proximal hamstring tendon repair

TL;DR

Higher pre-surgery activity levels and sport-related injuries are linked to better 2-year recovery after hamstring tendon repair surgery.

Contribution

Identifies pre-operative activity level and sport/recreation injury mechanism as predictors of 2-year outcomes after proximal hamstring repair.

Findings

PHAT scores improved by 47.1 points two years post-surgery, with most patients meeting the minimal important change threshold.

Baseline Tegner Activity Scale and sport/recreation injury mechanism were significant predictors of 2-year PHAT scores.

Despite strong clinical improvements, no factors were associated with patient satisfaction at two years.

Abstract

Surgical repair of proximal hamstring tendon ruptures has demonstrated encouraging outcomes and satisfaction rates, superior to non-operative management. This study sought to investigate injury, surgical and post-operative factors associated with clinical outcome and satisfaction 2-years after proximal hamstring tendon repair of acute tendon injuries.

This study included 59 patients undergoing proximal hamstring repair for acute tendon ruptures. Clinical assessment pre-operatively and 2-years post-operatively included the Perth Hamstring Assessment Tool (PHAT), Lower Extremity Functional Scale (LEFS) and Tegner Activity Scale (TAS). Regression analysis assessed the contribution of pre-operative patient (age, sex, body mass index, TAS), injury/surgery (time from injury to surgery, injury mechanism, semimembranosus and conjoint tendon retraction) and post-operative (peak isokinetic knee flexor strength) variables, to the 2-year PHAT and reporting complete satisfaction.

From baseline to 2-years, the PHAT improved by 47.1 points (95% CI, 41.9 to 52.3; p < 0.001), with 97.1% of patients meeting the PHAT minimal important change of 8.6 points by 2 years post-surgery. Furthermore, the LEFS improved by 44.5 points (95% CI, 39.9 to 49.1; p < 0.001) and TAS by 2.6 points (95% CI, 2.1 to 3.2; p < 0.001). Forty-six (78.0%) patients were ‘very satisfied’ with their 2-year outcome. Univariable analysis indicated that age (p = 0.004), baseline TAS (p = 0.006), a sport/recreation injury mechanism (p < 0.001) and 6-month normalized knee flexor torque (p = 0.030) were associated with the 2-year PHAT. In the final multivariable model, only the baseline TAS (p = 0.021) and a sport/recreation injury mechanism (p = 0.001) remained. No variable was significantly associated with being ‘very satisfied’ with 2-year surgical outcome.

Clinical scores improved significantly from baseline to 2 years after proximal hamstring repair. While pre-operative TAS and a sport/recreation injury mechanism were associated with the 2-year PHAT, no variables were associated with being ‘very satisfied’ with the 2-year outcome.

Prospective cohort study, Level of evidence 3.

Figures