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Li ZI, Buldo-Licciardi M, Moore M, Kanakamedala A, Burke CJ, Samim MM, Youm T. Assessment of fatty infiltration of the hamstring muscles in chronic proximal hamstring ruptures and effect on clinical outcomes after surgical repair: a novel application of the Goutallier classification. Arch Orthop Trauma Surg 2024; 144:2171-2179. [PMID: 38480556 DOI: 10.1007/s00402-024-05255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/18/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Increased time to surgery has been previously associated with poorer clinical outcomes after surgical treatment of proximal hamstring ruptures, though the etiology remains unclear. The purpose of this study was to evaluate whether degree of muscle atrophy, as assessed using the Goutallier classification system, is associated with worse outcomes following surgical treatment of chronic proximal hamstring ruptures. MATERIALS AND METHODS This was a retrospective case series of patients who underwent repair of proximal hamstring ruptures from 2012 to 2020 with minimum 2-year follow-up. Patients were included if they underwent primary repair of a proximal hamstring rupture ≥ 6 weeks after the date of injury and had accessible preoperative magnetic resonance imaging (MRI). Exclusion criteria were allograft reconstruction, endoscopic repair, or prior ipsilateral hip surgery. Patients were administered validated surveys: the modified Harris Hip Score (mHHS) and Perth Hamstring Assessment Tool (PHAT). Fatty atrophy on preoperative MRI was independently graded by two musculoskeletal radiologists using the Goutallier classification. Multivariate regression analysis was performed to evaluate associations of preoperative characteristics with muscle atrophy, as well as mHHS and PHAT scores. RESULTS Complete data sets were obtained for 27 patients. A majority of this cohort was male (63.0%), with a mean age of 51.5 ± 11.8 years and BMI of 26.3 ± 3.8. The mean follow-up time was 62.6 ± 23.1 months, and the mean time from injury-to-surgery was 20.4 ± 15.3 weeks. The Goutallier grading inter-reader weighted kappa coefficient was 0.655. Regression analysis demonstrated that atrophy was not significantly associated with PHAT (p = 0.542) or mHHS (p = 0.574) at latest follow-up. Increased age was significantly predictive of muscle atrophy (β = 0.62, p = 0.005) and was also found to be a significant predictor of poorer mHHS (β = - 0.75; p = 0.037). CONCLUSIONS The degree of atrophy was not found to be an independent predictor of clinical outcomes following repair of chronic proximal hamstring ruptures. Increasing age was significantly predictive of increased atrophy and poorer patient-reported outcomes.
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Affiliation(s)
- Zachary I Li
- Department of Orthopedic Surgery, NYU Langone Health, 333 E 38th St, New York, NY, 10016, USA.
- Tufts University School of Medicine, Boston, MA, USA.
| | - Michael Buldo-Licciardi
- Department of Orthopedic Surgery, NYU Langone Health, 333 E 38th St, New York, NY, 10016, USA
| | - Michael Moore
- Department of Orthopedic Surgery, NYU Langone Health, 333 E 38th St, New York, NY, 10016, USA
| | - Ajay Kanakamedala
- Department of Orthopedic Surgery, NYU Langone Health, 333 E 38th St, New York, NY, 10016, USA
| | | | | | - Thomas Youm
- Department of Orthopedic Surgery, NYU Langone Health, 333 E 38th St, New York, NY, 10016, USA
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Wong SE, Julian KR, Carpio JG, Zhang AL. Proximal Hamstring Repair With All-Suture Anchors and an Accelerated Rehabilitation and Bracing Protocol Demonstrates Good Outcomes at 1-Year Follow-Up. Arthrosc Sports Med Rehabil 2024; 6:100891. [PMID: 38362482 PMCID: PMC10867423 DOI: 10.1016/j.asmr.2024.100891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
Purpose To evaluate patient-reported outcomes and risk for rerupture after surgical treatment of proximal hamstring tendon ruptures using all-suture anchors and a unique postoperative bracing strategy. Methods A retrospective review of a prospectively collected database was conducted of patients undergoing proximal hamstring repair or reconstruction from 2020 to 2022 at a tertiary, academic institution. Patients were included if they reached minimum 1-year follow-up and completed postoperative patient-reported outcomes. The surgical protocol for proximal hamstring repairs included all-suture anchors placed either in an open or endoscopic fashion in the ischial tuberosity. After surgery, all patients underwent an accelerated rehabilitation protocol, including 6 weeks touchdown weight-bearing in a hinged knee brace locked in extension for ambulation, allowing passive knee flexion to 90° while seated. Descriptive statistics were used to analyze the data. Results Twenty-one patients were included (mean age 50.4 ± 9.5 years, body mass index 24.4 ± 3.5, 66.7% female). Lower Extremity Functional Scale score achieved postoperatively was 74.2 ± 7.5 (out of 80). Patients had minimal pain (mean visual analog scale pain score of 0.9 ± 1.2). 61.9% of patients were able to return to the same level of activity after based on Tegner score by 1 year. Postoperative Single Assessment Numeric Evaluation activity of daily living was 94.3 ± 8.3, and Single Assessment Numeric Evaluation Sports was 82.3 ± 19.0. Mean Short Form Survey (SF-12) postoperative scores were 51.6 ± 6.8 for SF-12 Physical Component Score and 53.9 ± 9.7 for Mental Component Score. 95.2% (20 of 21) patients were satisfied with their outcome. There were no reruptures, infections, or reoperations. One patient of 21 (4.8%) incurred a postoperative deep venous thrombosis, which was treated with therapeutic anticoagulation for 3 months. Conclusions All-suture anchors for proximal hamstring repair with a unique accelerated postoperative rehabilitation and bracing protocol result in good outcomes and patient satisfaction with minimal risk of complications. Level of Evidence Level IV, case series, therapeutic.
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Affiliation(s)
- Stephanie E. Wong
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Kaitlyn R. Julian
- School of Medicine, University of California San Francisco, San Francisco, California, U.S.A
| | - Jocelyn G. Carpio
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
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Wyatt PB, Ho TD, Hopper HM, Satalich JR, O’Neill CN, Cyrus J, Vap AR, O’Connell R. Systematic Review of Bracing After Proximal Hamstring Repair. Orthop J Sports Med 2024; 12:23259671241230045. [PMID: 38405008 PMCID: PMC10894551 DOI: 10.1177/23259671241230045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 02/27/2024] Open
Abstract
Background Traditionally, postoperative rehabilitation protocols after proximal hamstring repair (PHR) for avulsion of the proximal hamstring tendon from its ischial insertion recommend bracing the hip and/or knee to protect the fixation. However, because of the cumbersome nature of these orthoses, recent studies have investigated outcomes in patients with postoperative protocols that do not include any form of postoperative bracing. Purpose To synthesize the current body of evidence concerning bracing versus nonbracing postoperative management of PHR. Study Design Systematic review; level of evidence, 4. Methods Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a thorough search of the PubMed/Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase (OVID) databases on March 24, 2023. We analyzed complication rates, reoperation rates, patient satisfaction, return to sport, and patient-reported outcomes of studies that used postoperative bracing versus studies that used no postoperative bracing after PHR with at least 12 months of follow-up. A total of 308 articles were identified after initial search. Results In total, 25 studies were included in this review: 18 studies (905 patients) on bracing and 7 studies (291 patients) on nonbracing after PHR. The overall complication rate in the braced patients was found to be 10.9%, compared with 12.7% in nonbraced patients. The rate of reoperation due to retear of the proximal hamstring was found to be 0.05% in braced patients and 3.1% in nonbraced patients. Patient-reported outcome measures were found to be higher at the final follow-up in braced versus nonbraced patients, and patient satisfaction was found to be 94.7% in braced studies compared with 88.9% in nonbraced studies. The rate of 12-month return to sport in athletic patients was 88.4% with bracing and 82.7% without bracing. Conclusion The findings of this review demonstrated lower complication and reoperation rates, higher patient-reported outcome scores, higher patient satisfaction, and a higher rate of return to sport in braced patients compared with nonbraced patients.
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Affiliation(s)
- Phillip B. Wyatt
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Tiffany D. Ho
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Haleigh M. Hopper
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - James R. Satalich
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Conor N. O’Neill
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - John Cyrus
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Alexander R. Vap
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Robert O’Connell
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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4
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Nishimura H, Yamaura K, Stetzelberger VM, Garcia AR, Hollenbeck JFM, Brown JR, Mologne MS, Uchida S, Philippon MJ. Biomechanical Comparison of Proximal Hamstring Reconstruction Using Distal Hamstring Graft Versus Fascia Lata Graft for Treatment of Chronic Hamstring Injury. Am J Sports Med 2023; 51:3756-3763. [PMID: 37975438 DOI: 10.1177/03635465231206464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Surgical reconstruction using autografts is often required in treating chronic proximal hamstring injuries where the hamstring has retracted >5 cm. There is a paucity of evidence that evaluates reconstructive procedures using the 2 most popular autografts, distal hamstring and fascia lata. PURPOSE To (1) compare failure load and elongation at failure between the proximal hamstring tendon reconstruction with distal hamstring and fascia lata grafts and (2) compare the stiffness between these reconstructions and the native state. STUDY DESIGN Controlled laboratory study. METHODS Seven pairs of human cadaveric hemipelvises (mean age, 60.4 ± 5.0 years; 6 male, 1 female) with no evidence of previous injury or abnormality were dissected to the proximal hamstring origin. Through use of a dynamic tensile testing system, each specimen underwent preconditioning followed by a distraction test to determine the native specimen stiffness. Each pair of specimens was assigned to undergo proximal hamstring reconstruction with distal hamstring and reconstruction with fascia lata. Each specimen then underwent preconditioning followed by pull to failure. The failure load, elongation at failure, mode of failure, and stiffness were determined for each repair. RESULTS The distal hamstring group exhibited a greater failure load (mean, 334 ± 108 N; P = .031) and higher stiffness (mean, 47.6 ± 16.0 N/mm; P = .009) compared with the fascia lata group (mean, 179 ± 78 N and 23.0 ± 11.2 N/mm, respectively). Although the stiffness of the repair state in the distal hamstring group (mean, 61.4 ± 13.4 N/mm) was not significantly different from that of the native state (mean, 47.6 ± 16.0 N/mm), the stiffness of the repair state in the fascia lata group (mean, 23.0 ± 11.2 N/mm) was significantly lower than that of the native state (mean, 60.1 ± 17.7 N/mm) (P < .0001). The elongation at failure of the distal hamstring graft group (mean, 33.0 ± 6.6 mm) was not significantly different from that of the fascia lata graft group (mean, 29.2 ± 14.9 mm) (P = .58). The most common modes of failure for the distal hamstring group (29% each) were at the repair site, at the graft-muscle interface, and at the muscle, while the most common modes of failure for the fascia lata graft were at the tendon-graft interface. CONCLUSION The distal hamstring group achieved higher failure load and stiffness than the fascia lata group, and stiffness of the distal hamstring group was not significantly different from that of the native tendon. Elongation at failure was not different between repair techniques. Although distal hamstring graft failure predominantly occurred in 3 distinct locations, failure of the fascia lata repair occurred predominantly at the tendon-graft interface. These cadaveric results suggest that it may be more clinically appropriate to use distal hamstring versus fascia lata for proximal hamstring reconstruction. CLINICAL RELEVANCE Our time-zero study suggests that the proximal hamstring reconstruction with distal hamstring could be the preferred surgical treatment for chronic hamstring injury over reconstruction with fascia lata. The failure load of reconstruction with distal hamstring was inferior to that of primary suture anchor, suggesting that rehabilitation after reconstruction should not be more aggressive than the standard postoperative rehabilitation protocol for acute repair.
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Affiliation(s)
| | - Kohei Yamaura
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | | | - Justin R Brown
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital University of Occupational and Environmental Health, Kitakyusyu, Fukuoka, Japan
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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5
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Lawson JJ, Abraham EA, Imbergamo CM, Sequeira SB, Dreese JC, Gould HP. Systematic Review of Complications Associated With Proximal Hamstring Tendon Repair. Orthop J Sports Med 2023; 11:23259671231199092. [PMID: 37781641 PMCID: PMC10536870 DOI: 10.1177/23259671231199092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 10/03/2023] Open
Abstract
Background Although several complications of proximal hamstring tendon ruptures have been reported in the literature, few studies have comprehensively analyzed the complication profile of proximal hamstring tendon repair. Purpose To identify the overall rate of complications following proximal hamstring tendon repair and to differentiate these complications into categories. Study Design Systematic review; Level of evidence, 4. Methods Included in this review were studies that examined surgical repair of proximal hamstring tendon ruptures; all studies were in English and had an evidence level of 4 or higher. No restrictions were made regarding publication date or methodological quality. Data regarding complications were extracted to calculate the overall complication rate as well as the rate of major and minor complications. A quantitative data synthesis was conducted using the chi-square test to compare the proportion of patients who experienced complications with the endoscopic versus open approach. Results A total of 43 articles including 2833 proximal hamstring tendon repairs were identified. The overall postoperative complication rate was 15.3% (n = 433). The rate of major complications was 4.6%, including a 1.7% rate of sciatic nerve injury, 0.8% rate of venous thromboembolism, 0.8% reoperation rate, 0.8% rerupture rate, and 0.4% rate of deep infection. Minor complications included a 2.4% rate of posterior femoral cutaneous nerve injury, 2.3% rate of persistent hamstring myopathy, 2.2% rate of persistent sitting pain, 1.8% rate of peri-incisional numbness, 1.1% rate of superficial infection, and 0.8% rate of hematoma/seroma. Conclusion Proximal hamstring tendon repair is associated with an overall complication rate of 15.3%, including a 4.6% rate of major complications.
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Affiliation(s)
- Jonathan J. Lawson
- MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, Maryland, USA
| | - Eliza A. Abraham
- MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, Maryland, USA
| | - Casey M. Imbergamo
- MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, Maryland, USA
| | - Sean B. Sequeira
- MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, Maryland, USA
| | - James C. Dreese
- MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, Maryland, USA
| | - Heath P. Gould
- MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, Maryland, USA
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6
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Looney AM, Day HK, Comfort SM, Donaldson ST, Cohen SB. Proximal Hamstring Ruptures: Treatment, Rehabilitation, and Return to Play. Curr Rev Musculoskelet Med 2023; 16:103-113. [PMID: 36757628 PMCID: PMC9943812 DOI: 10.1007/s12178-023-09821-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE OF REVIEW To assess the current literature surrounding the treatment and rehabilitation strategies surrounding proximal hamstring rupture injuries, along with comparative return to sport and patient-reported outcomes. RECENT FINDINGS A high degree of variability exists in protective and rehabilitation strategies after both operative and non-operative proximal hamstring rupture management. Acceptable outcomes after both operative and non-operative management have been observed but may vary greatly with injury chronicity, severity, and surgical technique. The high complication rates observed after surgical treatment, along with poor functional outcomes that may occur in the setting of non-operative treatment or delayed surgery, highlight the importance of early injury evaluation and careful patient selection. Further high-quality research elucidating clearer indications for early operative management and an optimized and standardized rehabilitation protocols may improve outcomes and return to sport experience and metrics for individuals sustaining proximal hamstring ruptures.
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Affiliation(s)
- Austin M. Looney
- The Rothman Orthopaedic Institute, Sports Medicine Division, 925 Chestnut St Fl 5, Philadelphia, PA 19107-4216 USA
| | - Hannah K. Day
- School of Medicine, Georgetown University, Washington, DC USA
| | | | | | - Steven B. Cohen
- The Rothman Orthopaedic Institute, Sports Medicine Division, 925 Chestnut St Fl 5, Philadelphia, PA 19107-4216 USA
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7
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Kanakamedala AC, Mojica ES, Hurley ET, Gonzalez-Lomas G, Jazrawi LM, Youm T. Increased time from injury to surgical repair in patients with proximal hamstring ruptures is associated with worse clinical outcomes at mid-term follow-up. Arch Orthop Trauma Surg 2023; 143:951-957. [PMID: 35316390 DOI: 10.1007/s00402-022-04421-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Prior studies of hamstring tendon tears have reported varied findings on whether increased delay from injury to surgery is associated with worse outcomes. The purpose of this study was to determine whether increased time from injury to surgical repair is associated with worse clinical outcomes in patients with proximal hamstring ruptures. MATERIALS AND METHODS Patients who underwent surgical repair of a proximal hamstring rupture from 2010 to 2019 were followed for a minimum of 24 months from surgery. A cutoff of 6 weeks from injury to the time of surgery was used to distinguish between acute and chronic ruptures. All patients completed patient-reported outcome measures (PROs) at the final follow-up. Multiple factors were analyzed for their effects on PROs including time to surgery, amount of tendon retraction, and demographics such as sex and age. RESULTS Complete data sets were obtained for 38 patients at a mean follow-up of 4.9 years. All data is reported as a mean ± standard deviation. Patients who underwent acute repair of proximal hamstring ruptures had significantly greater Perth Hamstring Assessment Tool (PHAT) scores than those who underwent chronic repair (76.9 ± 18.8 vs 60.6 ± 18.2, p = 0.01). Increased time to surgery was significantly correlated with worse PHAT scores (ρ = - 0.47, p = 0.003). There was no difference in PROs based on the amount of tendon retraction, number of tendons torn, sex, smoking status, or BMI. CONCLUSIONS This study found that acute repair performed within 6 weeks of injury appears to yield improved PROs compared to chronic repair. These data highlight the importance of timely and accurate diagnosis of proximal hamstring ruptures and early operative intervention for surgical candidates.
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Affiliation(s)
- Ajay C Kanakamedala
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th st, 14th floor, New York, NY, 10003, United States.
| | - Edward S Mojica
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th st, 14th floor, New York, NY, 10003, United States
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th st, 14th floor, New York, NY, 10003, United States
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th st, 14th floor, New York, NY, 10003, United States
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th st, 14th floor, New York, NY, 10003, United States
| | - Thomas Youm
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th st, 14th floor, New York, NY, 10003, United States
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8
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Rudisill SS, Kucharik MP, Varady NH, Martin SD. Evidence-Based Management and Factors Associated With Return to Play After Acute Hamstring Injury in Athletes: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211053833. [PMID: 34888392 PMCID: PMC8649106 DOI: 10.1177/23259671211053833] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/10/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Considering the lengthy recovery and high recurrence risk after a hamstring injury, effective rehabilitation and accurate prognosis are fundamental to timely and safe return to play (RTP) for athletes. Purpose: To analyze methods of rehabilitation for acute proximal and muscular hamstring injuries and summarize prognostic factors associated with RTP. Study Design: Systematic review; Level of evidence, 4. Methods: In August 2020, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus were queried for studies examining management and factors affecting RTP after acute hamstring injury. Included were randomized controlled trials, cohort studies, case-control studies, and case series appraising treatment effects on RTP, reinjury rate, strength, flexibility, hamstrings-to-quadriceps ratio, or functional assessment, as well as studies associating clinical and magnetic resonance imaging factors with RTP. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials or the Methodological Index for Non-Randomized Studies (MINORS). Results: Of 1289 identified articles, 75 were included. The comparative and noncomparative studies earned MINORS scores of 18.8 ± 1.3 and 11.4 ± 3.4, respectively, and 12 of the 17 randomized controlled trials exhibited low risk of bias. Collectively, studies of muscular injury included younger patients and a greater proportion of male athletes compared with studies of proximal injury. Surgery for proximal hamstring ruptures achieved superior outcomes to nonoperative treatment, whereas physiotherapy incorporating eccentric training, progressive agility, and trunk stabilization restored function and hastened RTP after muscular injuries. Platelet-rich plasma injection for muscular injury yielded inconsistent results. The following initial clinical findings were associated with delayed RTP: greater passive knee extension of the uninjured leg, greater knee extension peak torque angle, biceps femoris injury, greater pain at injury and initial examination, “popping” sound, bruising, and pain on resisted knee flexion. Imaging factors associated with delayed RTP included magnetic resonance imaging-positive injury, longer lesion relative to patient height, greater muscle/tendon involvement, complete central tendon or myotendinous junction rupture, and greater number of muscles injured. Conclusion: Surgery enabled earlier RTP and improved strength and flexibility for proximal hamstring injuries, while muscular injuries were effectively managed nonoperatively. Rehabilitation and athlete expectations may be managed by considering several suitable prognostic factors derived from initial clinical and imaging examination.
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Affiliation(s)
- Samuel S Rudisill
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA.,Rush Medical College of Rush University, Chicago, Illinois, USA
| | - Michael P Kucharik
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA
| | - Nathan H Varady
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Scott D Martin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA
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Pihl E, Jonsson KB, Berglöf M, Brodin N, Sköldenberg O, Hedbeck CJ. Exploring the Perth Hamstring Assessment Tool and Lower Extremity Functional Scale in a Proximal Hamstring Avulsion Cohort: A Cross-sectional Study. Am J Sports Med 2021; 49:1732-1740. [PMID: 33909488 DOI: 10.1177/03635465211008568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The goal of treatment for a proximal hamstring avulsion (PHA) is an objectively restored muscle and a subjectively satisfied, pain-free patient at follow-up. Different self-reported and performance-based outcome measures have been used to evaluate recovery, but their validity is poorly investigated. PURPOSE To investigate (1) the correlation between the commonly used self-reported outcome measurements, the Perth Hamstring Assessment Tool (PHAT) and the Lower Extremity Functional Scale (LEFS); (2) to what extent these scores can be explained by physical dysfunction as measured by performance-based tests; (3) whether performance-based tests can discriminate between the injured and uninjured extremity; and (4) which activity limitations are perceived by patients several years after the injury. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS We included a consecutive series of patients treated for or diagnosed with PHA in our department between 2007 and 2016 having at least 2 tendons avulsed from the ischial tuberosity. Participants attended 2 study visits, answered questionnaires (PHAT, LEFS, and Patient-Specific Functional Scale [PSFS]), and performed physical performance-based tests (single-leg hop tests, single-step down test, and isometric and isokinetic strength tests). RESULTS A total of 50 patients were included (26 men [52%], 24 women [48%]; mean age, 50.9 years [SD, 9.8 years]). The mean follow-up time was 5.5 years (SD, 2.7 years), and 74% had been surgically treated. The correlation between PHAT and LEFS was strong (r = 0.832) and statistically significant (P < .001). Seven of the performance-based tests exhibited a statistically significant but weak correlation with LEFS (0.340-0.488) and 3 of the tests to PHAT (-0.304 to 0.406). However, only peak torque could significantly discriminate between the extremities. The activity limitation most commonly mentioned in PSFS was running (16 patients [32%]). CONCLUSION Although PHAT and LEFS correlated strongly, the correlations between functional tests and the patient-reported outcome scores were weak, and most functional tests failed to discriminate between the injured and uninjured lower extremity in patients with PHA 5 years after injury. In general, patients alleged few activity limitations, but running difficulty was a common sequela after PHA.
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Affiliation(s)
- Elsa Pihl
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.,Danderyd University Hospital Corp, Department of Orthopaedics, Stockholm, Sweden
| | - Kenneth B Jonsson
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Mida Berglöf
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Södersjukhuset, Department of Hand Surgery, Stockholm, Sweden
| | - Nina Brodin
- Danderyd University Hospital Corp, Department of Orthopaedics, Stockholm, Sweden.,Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.,Danderyd University Hospital Corp, Department of Orthopaedics, Stockholm, Sweden
| | - Carl Johan Hedbeck
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.,Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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10
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Reza T, Hinkle AJ, Perez-Chaumont A, Brown SM, Mulcahey MK. Systematic Review of Outcome Measures Used After Proximal Hamstring Repair. Orthop J Sports Med 2021; 9:23259671211005101. [PMID: 33997081 PMCID: PMC8113800 DOI: 10.1177/23259671211005101] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Patient-reported outcome measures are important to determine outcomes after
orthopaedic procedures. There is currently no standard for outcome measures
in the evaluation of patient outcomes after proximal hamstring repair. Purpose: To identify and evaluate outcome measures used after proximal hamstring
repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed to identify all English-language articles
assessing outcomes after proximal hamstring repair in PubMed, Embase, CINAHL
via EBSCOhost, MEDLINE via OvidSP, and Web of Science between 2000 and 2019.
After duplicates were removed, studies were selected using eligibility
criteria established by the authors. Image reviews, anatomic/histology
studies, literature reviews, surgical technique reports, systematic reviews,
narrative reviews, case studies, and studies with <5 patients were
excluded. Extraction, synthesis, and analysis of outcome measure data were
performed using Microsoft Excel. Quality assessment of included studies was
performed using Methodological Index for Non-Randomized Studies
criteria. Results: After duplicate articles were removed, a total of 304 unique articles were
identified and 27 met the inclusion criteria. The mean number of patients
with proximal hamstring repairs per study was 40. The most frequently
reported outcome measures were return to sport (14/27; 51.9%), custom
survey/questionnaire (13/27; 48.1%), and isokinetic hamstring strength
testing (13/27; 48.1%). Six of the 10 most commonly used outcome measures
were validated and included Lower Extremity Functional Scale, 12-Item Short
Form Health Survey, visual analog scale for pain, Perth Hamstring Assessment
Tool (PHAT), Single Assessment Numeric Evaluation, and Tegner Activity
Scale. Of those, PHAT was the only validated outcome measure designed for
proximal hamstring repair. Conclusion: There is currently no consensus on the best outcome measurements for the
evaluation of patients after proximal hamstring repair. We recommend an
increased commitment to the use of return to sport, isokinetic strength
testing, Lower Extremity Functional Scale, and PHAT when assessing such
injuries. Future studies should aim to define the most reliable methods of
outcome measurement in this patient population through consistent use of
tools that are clinically relevant and important to patients and can easily
be employed in a variety of clinical scenarios.
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Affiliation(s)
- Tara Reza
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Andrew J Hinkle
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | | | - Symone M Brown
- Department of Orthopaedic Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
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11
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Sheean AJ, Arner JW, Bradley JP. Proximal Hamstring Tendon Injuries: Diagnosis and Management. Arthroscopy 2021; 37:435-437. [PMID: 33546782 DOI: 10.1016/j.arthro.2020.12.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/15/2020] [Indexed: 02/02/2023]
Abstract
Proximal hamstring tendon injuries are common among active and athletic populations and exist on a spectrum ranging from proximal tendinopathy to partial tears to complete avulsions. Imaging should include plain radiography as bony avulsions have been observed in skeletally immature patients. Magnetic resonance imaging is diagnostic in the setting of both partial tears and complete tears. A high-intensity (on T2-weighted images), crescent-shaped signal at the tendon-bone interface ("sickle sign") is indicative of a partial-thickness tear of the proximal hamstring tendons. In the setting of complete avulsions, magnetic resonance imaging is also useful in demonstrating the extent of tendon avulsion and quantifying the number of tendons torn. Nonoperative treatment for proximal tendinopathy, acute partial tears, and complete tears with minimal tendon retraction includes activity modification, eccentric stretching and strengthening, and potentially platelet rich plasma injections. Surgical repair should be considered for partial tears refractory to nonoperative management, acute tears with greater than 2 cm of distal retraction, and/or chronic retracted tears. The surgical approach is generally made through a transverse incision within the gluteal crease, which can be extended distally in a "T" configuration in the setting of chronic retracted tears. In the setting of chronic retracted tears, a sciatic nerve neurolysis may be required owing to scarring. Following the surgical procedure, a graduated rehabilitation protocol is commenced with the expectation for a return to full, unrestricted activities by 6 months postoperative, and excellent outcomes can be anticipated. Compared with repair of chronic tears, acute repairs have improved functional outcomes and lower re-tear rates.
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Affiliation(s)
- Andrew J Sheean
- San Antonio Military Medical Center, San Antonio, Texas, U.S.A
| | - Justin W Arner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A..
| | - James P Bradley
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
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12
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Shilt J, McHorse G, Moisiuc A, Kushare I. Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair: Running title: Chemoprotection for hamstring avulsion fractures. J Clin Orthop Trauma 2021; 12:172-176. [PMID: 33716443 PMCID: PMC7920335 DOI: 10.1016/j.jcot.2020.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/27/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Surgical treatment for avulsion injuries of the proximal hamstrings has gained increasing popularity over the past decade. Despite good outcomes, early failures have been noted and have been attributed to slipping and falling, postoperative muscle spasm, or early mobilization. In a recent review of hamstring repair rehabilitation protocols, it was shown that there is marked variability in post-operative management. Post-operative bracing with limiting knee extension and hip flexion is the standard of care in most early rehabilitation protocols. Braces with limitation of hip flexion and knee locked in 900 flexion can be awkward, cumbersome and create fall risk.Chemoprotection has more recently been proposed to be an alternative approach to prevent tendon repair failure and controlled mobilization which has been shown to be superior to complete immobilization. We present the first case series of the use of botulinum toxin for chemo-protection of the proximal hamstring ischial avulsion repair, demonstrating its safety and efficacy. METHODS Retrospective case series at a tertiary children's hospital which included patients <18 years of age who underwent interventional treatment for proximal hamstring avulsion injuries of the ischium utilizing botulinum toxin as a chemoprotective agent. Data collected included demographic data, injury and treatment details, imaging, post-operative rehabilitation and return to activity. Descriptive statistical analysis was conducted. RESULTS Five male patients with mean age 14 years (12-17) were included in the study. All were sports related non-contact injuries. Radiographs showed displaced avulsion fractures in all 5 patients. All patients had failed conservative management initially; mean time to surgery from initial injury was 34.4 weeks. 4 patients underwent open reduction and internal fixation (ORIF), 1 patient with less displacement had bone marrow aspirate (BMA) injection; all had chemoprotection using botulinum toxin injected in the hamstrings. No patient required hip immobilization or knee immobilization locked to 90°. We elected to use a brace locked at 20° knee flexion in 2/5 patients. All patients underwent supervised physical therapy and achieved symmetric knee range of motion (ROM). Post-operative radiographs confirmed healing of the avulsion fracture in all 5 patients and they all returned to previous level of activity at mean 32 weeks (21-43) from surgery. None of the patients had a hamstring re-injury at mean follow up of 27 months (11-42). CONCLUSION Our case series is the first in literature that shows the safety and efficacy of chemoprotection with botulinum toxin for the post-operative management of avulsion injuries of proximal hamstrings, by minimizing the need for cumbersome bracing and allowing controlled motion during physical therapy.
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Affiliation(s)
- Jeffrey Shilt
- Department of Orthopedic Surgery, Texas Children’s Hospital, 17580 Interstate 45 South, The Woodlands, TX, 77384, USA,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Grant McHorse
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Alexis Moisiuc
- Department of Orthopedic Surgery, Texas Children’s Hospital, 17580 Interstate 45 South, The Woodlands, TX, 77384, USA
| | - Indranil Kushare
- Department of Orthopedic Surgery, Texas Children’s Hospital, 17580 Interstate 45 South, The Woodlands, TX, 77384, USA,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA,Corresponding author. D 17580 Interstate 45 South, The Woodlands, TX, 77384, USA.
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13
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Abstract
Aims Despite the increase in the surgical repair of proximal hamstring tears, there exists a lack of consensus in the optimal timing for surgery. There is also disagreement on how partial tears managed surgically compare with complete tears repaired surgically. This study aims to compare the mid-term functional outcomes in, and operating time required for, complete and partial proximal hamstring avulsions, that are repaired both acutely and chronically. Methods This is a prospective series of 156 proximal hamstring surgical repairs, with a mean age of 48.9 years (21.5 to 78). Functional outcomes were assessed preinjury, preoperatively, and postoperatively (six months and minimum three years) using the Sydney Hamstring Origin Rupture Evaluation (SHORE) score. Operating time was recorded for every patient. Results Overall, significant improvements in SHORE scores were seen at both six months and mid-term follow-up. Preoperatively, acute patients (median score 27.1 (interquartile range (IQR) 22.9)) reported significantly poorer SHORE scores than chronic patients (median score 42.9 (IQR 22.1); p < 0.001). However, this difference was not maintained postoperatively. For partial tears, acutely repaired patients reported significantly lower preoperative SHORE scores compared to chronically reapired partial tears (median score 24.3 (IQR 15.7) vs median score 40.0 (IQR 25.0); p < 0.001) but also significantly higher SHORE scores at six-month follow-up compared to chronically repaired partial tears (median score 92.9 (IQR 10.7) vs. median score 82.9 (IQR 14.3); p < 0.001). For complete tears, there was only a difference in preoperative SHORE scores between acute and chronic groups. Overall, acute repairs had a significantly shorter operating time (mean 64.67 minutes (standard deviation (SD) 12.99)) compared to chronic repairs (mean 74.71 minutes (SD = 12.0); t = 5.12, p < 0.001). Conclusion Surgical repair of proximal hamstring avulsions successfully improves patient reported functional outcomes in the majority of patients, irrespective of the timing of their surgery or injury classification. However, reducing the time from injury to surgery is associated with greater improvement in patient outcomes and an increased likelihood of returning to preinjury functional status. Acute repair appears to be a technically less complex procedure, as indicated by reduced operating times, postoperative neurological symptoms and number of patients requiring bracing. Acute repair is therefore a preference among many surgeons. Cite this article: Bone Joint J 2020;102-B(10):1419–1427.
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Affiliation(s)
- David Wood
- North Sydney Orthopaedics and Sports Medicine Centre, Sydney, Australia
| | - Sofie R. French
- Australian Institute of Musculoskeletal Research, Sydney, Australia
| | - Selin Munir
- Australian Institute of Musculoskeletal Research, Sydney, Australia
| | - Rajiv Kaila
- North Sydney Orthopaedics and Sports Medicine Centre, Sydney, Australia
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14
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Excellent clinical outcome and low complication rate after proximal hamstring tendon repair at mid-term follow up. Knee Surg Sports Traumatol Arthrosc 2020; 28:1230-1235. [PMID: 31650312 DOI: 10.1007/s00167-019-05748-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/09/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Proximal hamstring tendon avulsions lead to a significant loss of strength and a functional deficit of the respective lower limb and surgery is the recommended treatment. Only little is known about the clinical outcomes and complications when comparing acute and chronic management as well as partial and complete tears. Therefore, the purpose of this study was to investigate the clinical results and the complication rate of patients after surgical treatment of proximal hamstring tendon injuries. It was hypothesized that surgical treatment of an acute proximal hamstring avulsion would lead to a superior clinical outcome with a low complication rate and high return to sports rate compared to chronic cases and partial avulsions. METHODS Patients who underwent proximal hamstring tendon repair between 2008 and 2015 were retrospectively evaluated with a minimum follow up of 2 years. Outcome measurements were obtained by means of Lysholm score, Harris Hip Score, Visual Analog Scale, and Tegner Activity Scale. Return to sports (RTS) rate was determined. Postoperative adverse events were recorded and complications reported. Patients' outcomes were compared between acute/chronic repair and partial/complete injury patterns. RESULTS Ninety-four of 120 (78.3%) were available for final assessment at a mean follow-up of 56.2 ± 27.2 months. Clinical outcome measures were excellent and did not differ between the treatment groups or between the different injury patterns. RTS was achieved by 86.2% of the patients and was significantly superior after acute treatment (p < 0.05). The overall complication rate was 8.5% and significantly higher in complete tears compared to partial tears and in delay compared to acute surgery (p < 0.05). CONCLUSION Surgical treatment of proximal hamstring tendon avulsions results in excellent clinical outcome scores and a high RTS rate. Open surgical treatment has shown to be a safe procedure with a low complication rate. Surgical timing is important, as early surgical intervention provides a higher RTS rate and a lower complication rate than delayed surgery and should therefore be preferred in clinical practice. Repair of partial and complete tears lead to similar clinical outcome, but a higher complication rate in complete avulsions. LEVEL OF EVIDENCE Level IV.
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15
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Abstract
AIMS To validate the Sydney Hamstring Origin Rupture Evaluation (SHORE), a hamstring-specific clinical assessment tool to evaluate patient outcomes following surgical treatment. METHODS A prospective study of 70 unilateral hamstring surgical repairs, with a mean age of 47.3 years (15 to 73). Patients completed the SHORE preoperatively and at six months post-surgery, and then completed both the SHORE and Perth Hamstring Assessment Tool (PHAT) at three years post-surgery. The SHORE questionnaire was validated through the evaluation of its psychometric properties, including; internal consistency, reproducibility, reliability, sensitivity to change, and ceiling effect. Construct validity was assessed using Pearson's correlation analysis to examine the strength of association between the SHORE and the PHAT. RESULTS The SHORE demonstrated an excellent completion rate (100%), high internal consistency (Cronbach's alpha 0.78), and good reproducibility (intraclass correlation coefficient (ICC) 0.82). The SHORE had a high correlation with the validated PHAT score. It was more sensitive in detecting clinical change compared to the PHAT. A ceiling effect was not present in the SHORE at six months; however, a ceiling effect was identified in both scores at three years post-surgery. CONCLUSION This study has validated the SHORE patient reported outcome measure (PROM) as a short, practical, reliable, valid, and responsive tool that can be used to assess symptom and function following hamstring injury and surgical repair. Cite this article: Bone Joint J 2020;102-B(3):388-393.
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Affiliation(s)
- Sofie R French
- Australian Institute of Musculoskeletal Research, Sydney, Australia
| | - Rajiv Kaila
- North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
| | - Selin Munir
- Australian Institute of Musculoskeletal Research, Sydney, Australia
| | - David G Wood
- North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
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16
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Moving forward in hip arthroscopy and related research. Knee Surg Sports Traumatol Arthrosc 2019; 27:3055-3056. [PMID: 31501962 DOI: 10.1007/s00167-019-05702-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
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17
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Schröder JH, Gesslein M, Schütz M, Perka C, Krüger DR. [Minimally invasive proximal hamstring insertion repair]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:419-434. [PMID: 30443745 DOI: 10.1007/s00064-018-0575-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Minimally invasive endoscopic reconstruction of avulsion injuries of the proximal hamstring insertion to prevent persistent weakness and pain. INDICATIONS Fresh retracted 2‑ and 3‑tendon avulsion injuries of the proximal hamstring insertion. Unsuccessful conservative therapy of less retracted injuries. Painful chronic partial lesions of the proximal hamstring insertion. CONTRAINDICATIONS Major comorbidities with an increased surgical risk, older patients with low functional demands. Chronic injuries without functional deficits. SURGICAL TECHNIQUE Endoscopic refixation using suture anchors after freshening the footprint on the tuber ischiadicum. Visualization of the sciatic nerve to ensure its protection. POSTOPERATIVE MANAGEMENT Partial loading with a knee brace for strict prevention of combined knee extension and hip flexion for 4-6 weeks. Start of active exercise and stretching 8 weeks postoperatively. RESULTS From 2014-2016, 12 patients were treated with an endoscopic reconstruction of the proximal hamstring insertion. After a mean follow-up of 25 months (range 16-34 months), an average visual analog scale (VAS) of 0 (range 0-2) and an average subjective assessment of function (Subjective Hip Value) of 94% (range 80-100%) were found. No neurovascular complications were seen in our collective, in particular no evidence of hypesthesia in the area of the posterior femoral cutaneous nerve. All patients were able to return to their original level of activity (Tegner Activity Scale 5.2 preoperatively vs. 5.2 postoperatively), while the average time until return to sport was 6.5 months (range 3-12 months). All patients were able to return to their original occupation.
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Affiliation(s)
- J H Schröder
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - M Gesslein
- Klinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - M Schütz
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - C Perka
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - D R Krüger
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
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