Objective To prospectively evaluate 1-year clinical and radiological outcomes after operative and non-operative treatment of proximal hamstring tendon avulsions. Methods Patients with an MRI-confirmed proximal hamstring tendon avulsion were included. Operative or non-operative treatment was selected by a shared decision-making process. The primary outcome was the Perth Hamstring Assessment Tool (PHAT) score. Secondary outcome scores were Proximal Hamstring Injury Questionnaire, EQ-5D-3L, Tegner Activity Scale, return to sports, hamstring flexibility, isometric hamstring strength and MRI findings including proximal continuity. Results Twenty-six operative and 33 non-operative patients with a median age of 51 (IQR: 37–57) and 49 (IQR: 45–56) years were included. Median time between injury and initial visit was 12 (IQR 6–19) days for operative and 21 (IQR 12–48) days for non-operative patients (p=0.004). Baseline PHAT scores were significantly lower in the operative group (32±16 vs 45±17, p=0.003). There was no difference in mean PHAT score between groups at 1 year follow-up (80±19 vs 80±17, p=0.97). Mean PHAT score improved by 47 (95% CI 39 to 55, p<0.001) after operative and 34 (95% CI 27 to 41, p<0.001) after non-operative treatment. There were no relevant differences in secondary clinical outcome measures. Proximal continuity on MRI was present in 20 (95%, 1 recurrence) operative and 14 (52%, no recurrences) non-operative patients (p=0.008). Conclusion In a shared decision-making model of care, both operative and non-operative treatment of proximal hamstring tendon avulsions resulted in comparable clinical outcome at 1-year follow-up. Operative patients had lower pretreatment PHAT scores but improved substantially to reach comparable PHAT scores as non-operative patients. We recommend using this shared decision model of care until evidence-based indications in favour of either treatment option are available from high-level clinical trials. Data are available on reasonable request.

中文翻译：

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近端腘绳肌腱撕脱：使用共享决策模型在 1 年随访中手术和非手术治疗的临床结果相当

目的前瞻性评价腘绳肌近端撕脱伤手术和非手术治疗后1年的临床和影像学结果。方法 纳入 MRI 证实的近端腘绳肌腱撕脱伤患者。通过共同的决策过程选择手术或非手术治疗。主要结果是珀斯腘绳肌评估工具（PHAT）评分。次要结果评分是近端腘绳肌损伤问卷、EQ-5D-3L、Tegner 活动量表、重返运动、腘绳肌柔韧性、等长腘绳肌力量和包括近端连续性在内的 MRI 结果。结果 包括 26 名手术患者和 33 名非手术患者，中位年龄分别为 51（IQR：37-57）和 49（IQR：45-56）岁。受伤和初次就诊之间的中位时间为手术患者 12 (IQR 6-19) 天，非手术患者为 21 (IQR 12-48) 天 (p=0.004)。手术组的基线 PHAT 评分显着降低（32±16 vs 45±17，p=0.003）。在 1 年的随访中，各组之间的平均 PHAT 评分没有差异（80±19 vs 80±17，p=0.97）。平均 PHAT 评分在手术后提高了 47（95% CI 39 至 55，p<0.001），在非手术治疗后提高了 34（95% CI 27 至 41，p<0.001）。次要临床结果测量没有相关差异。20 名（95%，1 名复发）手术患者和 14 名（52%，无复发）非手术患者（p=0.008）在 MRI 上存在近端连续性。结论 在共享的护理决策模型中，近端腘绳肌腱撕脱的手术和非手术治疗在 1 年的随访中产生了相当的临床结果。手术患者的治疗前 PHAT 评分较低，但显着改善，达到与非手术患者相当的 PHAT 评分。我们建议使用这种共享决策模型，直到从高水平临床试验中获得支持任一治疗方案的循证适应症。可根据合理要求提供数据。