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Surgery for bilateral proximal hamstring tears yields good functional outcomes
Patients with partial avulsions had higher Modified Perth Hamstring Scores.
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Surgical repair of bilateral proximal hamstring tears improved outcomes and decreased pain based on results of a retrospective study that was presented recently. More than half of patients studied returned to their pre-injury level of activity, according to investigators.
“Surgery was effective in all cases,” Navraj Atwal, FRCS (Tr & Orth), a locum consultant in lower limb arthroplasty at University of Bristol, in Bristol, United Kingdom, said.
This study was a 13-year retrospective review of a single surgeon’s series of more than 400 patients. Twelve patients with bilateral, asynchronous injuries were identified from a prospectively collected database. Ten patients were treated with staged procedures and two patients underwent bilateral repair of torn hamstring tendons.
Similar rehab, some were braced
Eight men and four women, whose average age was 51 years, were included in the study. The mean follow-up was 38.25 months.
Each patient completed the Modified Perth Hamstring Score (MPHS), a five-part scoring system that measures pain, function, current activity level and return to pre-injury activity level. The MPHS also assesses whether patients would have the surgery again. The mean MPHS outcome score was 84 points.
All patients performed a similar rehabilitation protocol. Patients with retracted chronic tears wore a knee brace until the muscle had stretched (2 weeks, minimum).
Images: Atwal N
Low-level trauma
Most of the patients’ injuries were caused by low-level trauma and were sustained when the hip was forcibly flexed with the knee in extension, Atwal said.
The patients presented with extensive bruising that was evident within 48 hours to 72 hours of injury, a palpable gap deformity and weakness. Some patients reported pain while seated, even in the early stages, according to Atwal.
Furthermore, patients described a “pop” in the back of their leg and complained of buttock and posterior thigh pain, he said.
Postoperatively patients reported that the pain associated with 22 of the torn hamstrings resolved.
“They were happy and not requiring analgesia,” Atwal said during the presentation.
Seven patients returned to pre-injury activities at the same level as before the injury. Of the five patients who were unable to do so, four patients indicated they had ongoing hamstring problems, according to Atwal.
“Interestingly, all patients were improved significantly enough that they would have surgery again,” he said.
Thirteen patients had complete avulsions, and 11 had partial avulsions. Of the 13 complete avulsions, about half of them were early repairs. Most of the partial avulsions were late repairs.
Outcome scores were higher in the partial avulsion group, according to Atwal.
“Patients with bilateral injuries appear to be a different patient group,” Atwal said. “They tend to be older, there is less trauma involved, and the partial avulsions treated late tended to do better. So this led us to believe this was a degenerative process and potentially a group like those with a degenerative rotator cuff tear.” – by Colleen Owens
- Reference:
- Atwal N. Paper #470. Presented at: British Orthopaedic Association Congress. Oct. 1-4, 2013. Birmingham, England.
- For more information:
- Navraj Atwal, FRCS (Tr & Orth), can be reached at Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire, GL53 7AN, United Kingdom; email: nav_atwal@hotmail.com.
Disclosure: Atwal has no relevant financial disclosures.