Subbu Raj, Benjamin-Laing Harry, Haddad Fares
Institute of Sport Exercise and Health, University College London Hospitals, London, UK
Institute of Sport Exercise and Health, University College London Hospitals, London, UK.
Am J Sports Med. 2015 Feb;43(2):385-91. doi: 10.1177/0363546514557938. Epub 2014 Nov 17.
Avulsion of the proximal hamstring origin is well documented, and surgical treatment is advocated for complete avulsions.
To compare the return to preinjury level of sport and the complexity of surgery in athletes undergoing surgical intervention for complete proximal hamstring avulsions within 6 weeks, 6 months, and after 6 months of injury.
Case series; Level of evidence, 4.
This was the largest case series from a tertiary referral center reported in the literature. A total of 112 athletes were included, with complete proximal avulsion injuries confirmed on MRI scans; 63 patients (56.3%) were high-level athletes. Patients were divided into subgroups depending on the timing of surgical intervention: "early" was defined within 6 weeks, "delayed" within 6 weeks to 6 months, and "late" after 6 months. All patients were surgically explored and repaired with the aim of comparing the timing between each group and the return to preinjury sport. All patients underwent an individualized rehabilitation protocol. There was no loss to follow-up. The primary outcome measure was the return to preinjury level sports activity.
A total of 108 patients (96.4%) returned to sport. In the early intervention group, the average time of return to play was 16 weeks, 9 weeks faster than the delayed group and 13 weeks faster than the late group. There were 2 partial reruptures in those with delayed intervention—both athletes retired from competitive sport but were recreationally active. Two other athletes recovered well but retired from playing at all levels. Twelve athletes (2 in the early intervention group, 5 in the delayed, 5 in the late) were delayed by local nerve symptoms. Only 2 cases required further exploration.
Early surgical intervention was associated with good clinical outcomes and a quicker return to sport; however, delaying the diagnosis can lead to prolonged morbidity and an increased likelihood of complications.
股后肌群近端起点撕脱已有充分记载，对于完全性撕脱主张手术治疗。
比较在损伤6周内、6个月内及6个月后接受手术干预的完全性股后肌群近端撕脱运动员恢复到伤前运动水平的情况以及手术的复杂性。
病例系列；证据等级，4级。
这是文献报道的来自三级转诊中心的最大病例系列。共纳入112名运动员，MRI扫描证实为完全性近端撕脱伤；63例患者（56.3%）为高水平运动员。根据手术干预时机将患者分为亚组：“早期”定义为6周内，“延迟”定义为6周～6个月，“晚期”定义为6个月后。所有患者均接受手术探查和修复，目的是比较各组之间的时机以及恢复到伤前运动的情况。所有患者均接受个体化康复方案。无失访情况。主要观察指标为恢复到伤前运动水平的情况。
共108例患者（96.4%）恢复运动。早期干预组平均重返赛场时间为16周，比延迟组快9周，比晚期组快13周。延迟干预患者中有2例部分再断裂——两名运动员退出竞技运动但仍有休闲活动。另外两名运动员恢复良好但完全停止了运动。12名运动员（早期干预组2例，延迟组5例，晚期组5例）因局部神经症状而延迟恢复。仅2例需要进一步探查。
早期手术干预临床效果良好且恢复运动更快；然而，延迟诊断会导致发病时间延长和并发症可能性增加。
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