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Study shows time to surgery is crucial to recovery after proximal hamstring avulsion
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A delay in surgery for a patient with a hamstring avulsion injury can lead to a longer delay in return to sport for athletes of all levels, according to results of a study conducted by Harry Benjamin-Laing, BSc, MBCh, MRCS, and colleagues.
The study, performed at the Institute of Sport Exercise and Health, in London, examined the outcomes of athletes at all levels of play with hamstring avulsions and how they returned to their level of sport after delays to surgery.
“The majority of our patients were high-level athletes, and at least ‘weekend warriors.’ The majority of our athletes were rugby or soccer players. They all returned to sport after surgery, but the ones who were high-level athletes who we operated on earliest returned to their previous level and sooner. If they were operated on later, they typically dropped down a level,” Benjamin-Laing told Orthopaedics Today Europe.
The study included 112 athletes (76 men and 36 women; average age 29 years ± 8.5 years) with complete proximal hamstring avulsions injuries confirmed on MRI; 63 patients were “high-level” athletes.
Athletes were placed into one of three subdivisions for the study, depending on their time to surgery, which were an early group that had surgery within 6 weeks of injury, a delayed group that had surgery between 6 weeks and 6 months of injury and a late group that had surgery after 6 months following injury.
The investigators described the study as the largest case series in the literature of avulsion of the proximal hamstring performed at a tertiary referral center.
“The majority of high level athletes we saw usually would present earlier because they get scans and are seen much earlier. It is much more likely that these kind of injuries get diagnosed for high-level athletes. This results in better outcomes because it does make the surgery less difficult if it is addressed sooner, in terms of you can avoid intraoperative challenges and postoperative complications. If they wait longer, the tissue becomes quite fibrous and the tissue planes are less clear,” Benjamin-Laing said.
If the injuries are treated in the early timeframe, surgeons can see the tissues easier compared with what they can see for a patient in the delayed group, he said, and this makes the surgery less difficult to complete.
The analysis of the results showed an average return to sport after surgery in the early group of 16 weeks. The return to sport in the delayed group was 25 weeks and it was 29 weeks in the late group. Athletes in the early group returned to sport on average 13 weeks faster than those in the late group, according to Benjamin-Laing.
“I think the key message is these kind of injuries need to be identified early. Certainly with advances in imaging and the recognition that this is potentially a career threatening injury, these injuries are being caught early. We need these patients to be treated in an expedited way for successful outcomes in terms of earlier return to high-level sport,” he said.
The researchers noted they will continue to collect data from the database of these injuries to see if the results change moving forward. – by Robert Linnehan
- Reference:
- Subbu R, et al. Am J Sports Med. 2015;doi:10.177/0363546514557938.
- For more information:
- Harry Benjamin-Laing, BSc, MBCh, MRCS, can be reached at University College London Hospitals, 235 Euston Rd., Fitzrovia, London NW1 2BU, United Kingdom; email: h.benjamin-laing@doctors.org.uk.
Disclosure: Benjamin-Laing reports no relevant financial disclosures.