Background:

Chronic incomplete proximal hamstring avulsion injuries are debilitating injuries associated with prolonged periods of convalescence and poor return to preinjury level of function. This study explores the efficacy of operative intervention for these injuries on patient satisfaction, muscle strength, range of motion, functional performance, return to preinjury level of sporting activity, and injury recurrence.

Hypothesis:

Surgical intervention of chronic incomplete proximal hamstring avulsion injuries enables return to preinjury level of sporting function with low risk of clinical recurrence.

Study Design:

Case series: Level of evidence, 4.

Methods:

This prospective single-surgeon study included 41 patients with incomplete proximal hamstring avulsion injuries refractory to 6 months of nonoperative treatment. All study patients underwent primary operative repair of the avulsed proximal hamstring tendon and received standardized postoperative rehabilitation. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 28.2 months (range, 25.0-35.0 months) from date of surgery.

Results:

All patients returned to their preinjury level of sporting activity. Mean ± SD time from surgery to return to full sporting activity was 22.2 ± 6.7 weeks. There were no episodes of clinical recurrence. At 3 months after surgery, 39 patients (95.1%) were satisfied/very satisfied with the outcomes of their surgery, and as compared with preoperative values, improvements were recorded in isometric hamstring muscle strength at 0° (84.9% ± 10.9% vs 40.4% ± 8.8%; P < .001), 15° (89.6% ± 7.6% vs 44.2% ± 11.1%; P < .001), and 45° (94.1% ± 5.1% vs 66.4% ± 9.0%; P < .001); mean passive straight leg raise angle (71.2°± 13.5° vs 45.4°± 11.9°; P < .001); mean lower extremity functional score (70.9 ± 5.1 vs 48.4 ± 5.2; P < .001); and mean Marx activity rating score (5.6 ± 2.8 vs 2.7 ± 1.0; P < .001). High patient satisfaction and functional outcome scores were maintained at 1- and 2-year follow-up.

Conclusion:

Operative repair of chronic incomplete proximal hamstring avulsion injuries enabled return to preoperative level of sporting function with no episodes of clinical recurrence at short-term follow-up. Surgical intervention was associated with high patient satisfaction and improved isometric hamstring muscle strength, range of motion, and functional outcome scores as compared with preoperative values. High patient satisfaction and improved functional outcomes were sustained at 2-year follow-up.

中文翻译：

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慢性不完全性近端腿筋撕脱伤的外科治疗。

背景：

慢性不完全性近端绳肌撕脱伤是使恢复期延长和恢复损伤前功能水平差的衰弱性损伤。这项研究探讨了针对这些损伤的手术干预对患者满意度，肌肉力量，运动范围，功能表现，恢复运动前的运动水平和损伤复发的功效。

假设：

慢性不完全性proximal绳肌近端撕脱伤的外科手术干预可使运动功能恢复到损伤前水平，且临床复发风险较低。

学习规划：

案例系列：证据水平，4。

方法：

这项前瞻性单手术研究包括41例因6个月的非手术治疗而难治的不完全的近端a绳撕脱伤。所有研究患者均接受了撕脱的近端绳肌腱的初次手术修复，并接受了标准化的术后康复。手术后定期记录预定结果。自手术日期算起，平均随访时间为28.2个月（范围25.0-35.0个月）。

结果：

所有患者恢复到受伤前的体育活动水平。从手术到恢复完全运动的平均±SD时间为22.2±6.7周。没有临床复发的发作。术后3个月，有39名患者（95.1％）对手术结果感到满意/非常满意，并且与术前相比，0°等距绳肌力量得到了改善（84.9％±10.9％vs 40.4） ％±8.8％; P <.001），15°（89.6％±7.6％vs 44.2％±11.1％; P <.001）和45°（94.1％±5.1％vs 66.4％±9.0％; P < .001）; 平均被动直腿抬高角度（71.2°±13.5°对45.4°±11.9°; P <.001）; 下肢平均功能评分（70.9±5.1 vs 48.4±5.2; P<.001）; 以及平均马克思活动等级评分（5.6±2.8与2.7±1.0；P <.001）。在1年和2年的随访中维持了较高的患者满意度和功能结局评分。

结论：

慢性不完全性近端腿筋撕脱伤的手术修复可以使患者恢复到术前的运动功能水平，短期随访中无临床复发。与术前值相比，外科手术干预可提高患者满意度，并改善等距绳肌力量，运动范围和功能结局评分。在2年的随访中维持了较高的患者满意度和改善的功能结局。