Surgery may improve function after proximal hamstring avulsion vs. nonoperative treatment
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Key takeaways:
- Surgical treatment of proximal hamstring avulsion injuries was associated with improved outcomes vs. nonoperative management.
- Surgery yielded improved function, return to sport and patient satisfaction.
Published results showed surgical treatment of proximal hamstring avulsion injuries was associated with improved functional outcomes at long-term follow-up compared with nonoperative treatment.
Nicolas Lefèvre, MD, orthopedic surgeon at the Clinique du Sport in Paris, and colleagues performed a retrospective comparative study of data from patients treated for a proximal hamstring avulsion injury between January 2012 and July 2021.
Lefèvre and colleagues compared outcomes between a cohort of 95 patients who underwent surgical treatment of the proximal hamstring avulsion injury at mean 5.7 months after injury and 32 patients who received nonoperative management of the proximal hamstring avulsion injury at a mean 12.7 months after injury.
According to the study, outcome measures were assessed at a minimum follow-up of 4 years and included the Parisian Hamstring Avulsion Score, Tegner activity score, University of California Los Angeles (UCLA) score, return to sport and patient satisfaction.
At final follow-up, mean Parisian Hamstring Avulsion Score was 86.3 for the surgical group at a mean 50.7 months and was 69.9 for the nonsurgical group at a mean 56.5 months. Lefèvre and colleagues also found patients who underwent surgery had higher Tegner activity scores and UCLA scores compared with patients who received nonoperative treatment.
Lefèvre and colleagues noted 68.4% of the surgical group returned to sport with 67.7% returning at the same or higher level, while 46.9% of the nonsurgical group returned to sport with 26.7% returning at the same or higher level. In addition, they noted 89.5% of the surgical group and 25% of the nonsurgical group reported high patient satisfaction after treatment.
“It is noteworthy that surgical intervention carries an additional 3% risk of complications, which in this study included issues such as re-rupture and paresthesia,” Lefèvre and colleagues wrote in the study. “This rate is comparable with the rate reported in the literature.”
Perspective
Back to TopShane J. Nho, MD, MS; Eric Hu, BS; and Jesus E. Cervantes, BS
Proximal hamstring avulsion injuries are commonly attributed to acute injury or chronic degeneration. Surgical repair of complete and high-grade partial tears has shown superior short-term outcomes in the literature.
The current study entitled “Surgical treatment of proximal hamstring avulsion injuries compared with nonsurgical treatment” by Nicolas Lefèvre, MD, and colleagues adds to the literature with a reliable methodology utilizing nonoperative control groups. This article provides a propensity-matched comparison between surgical and nonsurgical management of proximal hamstring avulsion injuries after a mean follow-up of more than 4 years. From a surgical perspective, the findings that surgical intervention results in superior outcomes compared with nonsurgical treatment align with what I often see in practice. Patients undergoing surgery, either endoscopically or open, tend to report significant functional improvements and high return to sport rates.
Lefèvre and colleagues report a mean diagnosis to treatment interval of 5.7 months in the surgical group vs. 12.7 months in the nonsurgical group. In addition, chronic tear classification was 81.1% in the surgical group and 81.3% in the nonsurgical group. We typically expect proximal hamstring avulsion injuries to be treated more acutely. Early surgical intervention can help optimize recovery, function and satisfaction in patients with proximal hamstring avulsion injuries. Usually, chronic tears reflect prolonged nonoperative management or delays in diagnosis, which may, in turn, contribute to poorer outcomes.
References:
Belk JW, et al. Orthop J Sports Med. 2019;doi:10.1177/2325967119853218.
Fenn TW, et al. Am J Sports Med. 2024;doi:10.1177/03635465231216118.
Lefèvre N, et al. Am J Sports Med. 2024;doi:10.1177/03635465241270139.
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