Bowman Eric N, Marshall Nathan E, Gerhardt Michael B, Banffy Michael B
Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Ascension Providence Rochester Hospital, Rochester, Michigan, USA.
Orthop J Sports Med. 2019 Feb 15;7(2):2325967118823712. doi: 10.1177/2325967118823712. eCollection 2019 Feb.
Proximal hamstring avulsions cause considerable morbidity. Operative repair results in improved pain, function, and patient satisfaction; however, outcomes remain variable.
To evaluate the predictors of clinical outcomes after proximal hamstring repair.
Case series; Level of evidence, 4.
We retrospectively reviewed proximal hamstring avulsions repaired between January 2014 and June 2017 with at least 1-year follow-up. Independent variables included patient demographics, medical comorbidities, tear characteristics, and repair technique. Primary outcome measures were the Single Assessment Numerical Evaluation (SANE), International Hip Outcome Tool-12 (iHOT-12), and Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip score. Secondary outcome measures included satisfaction, visual analog scale for pain, Tegner score, and timing of return to sports.
Of 102 proximal hamstring repairs, 86 were eligible, 58 were enrolled and analyzed (67%), and patient-reported outcomes were available for 45 (52%), with a mean 29-month follow-up. The mean patient age was 51 years, and 57% were female. Acute tears accounted for 66%; 78% were complete avulsions. Open repair was performed on 90%. Overall satisfaction was 94%, although runners were less satisfied compared with other athletes ( = .029). A majority of patients (88%) returned to sports by 7.6 months, on average, with 72% returning at the same level. Runners returned at 6.3 months, on average, but to the same level 50% of the time and at a decreased number of miles per week compared to nonrunners (15.7 vs 7.8, respectively; < .001). Postoperatively, 78% had good/excellent SANE Activity scores, but the mean Tegner score decreased (from 5.5 to 5.1). Acute tears had higher SANE Activity scores. The mean iHOT-12 and KJOC scores were 99 and 77, respectively. Endoscopic repairs had equivalent outcome scores to open repairs, although conclusions were limited given the small number of patients in the endoscopic group. Greater satisfaction was noted in patients older than 50 years ( = .024), although they were less likely to return to running ( = .010).
Overall, patient satisfaction and functionality were high. With the numbers available, we were unable to detect any significant differences in functional outcome scores based on patient age, sex, body mass index, smoking status, medical comorbidities, tear grade, activity level, or open versus endoscopic technique. Acute tears had better SANE Activity scores. Runners should be cautioned that they may be unable to return to the same preinjury activity level after proximal hamstring repair.
When counseling patients with proximal hamstring tears, runners and those with chronic tears should set appropriate expectations.
腘绳肌近端撕脱伤会导致相当严重的发病率。手术修复可改善疼痛、功能和患者满意度；然而，结果仍存在差异。
评估腘绳肌近端修复术后临床结果的预测因素。
病例系列；证据等级，4级。
我们回顾性分析了2014年1月至2017年6月间接受腘绳肌近端撕脱伤修复且至少随访1年的患者。自变量包括患者人口统计学特征、内科合并症、撕裂特征和修复技术。主要结局指标为单项评估数值评定法（SANE）、国际髋关节结局工具-12（iHOT-12）和克伦-乔布骨科诊所（KJOC）运动髋关节评分。次要结局指标包括满意度、疼痛视觉模拟量表、特格纳评分以及恢复运动的时间。
在102例腘绳肌近端修复病例中，86例符合条件，58例纳入分析（67%），45例（52%）有患者报告的结局，平均随访29个月。患者平均年龄为51岁，57%为女性。急性撕裂占66%；78%为完全撕脱伤。90%进行了开放修复。总体满意度为94%，尽管跑步者与其他运动员相比满意度较低（P = 0.029）。大多数患者（88%）平均在7.6个月时恢复运动，72%恢复到相同水平。跑步者平均在6.3个月时恢复运动，但50%的时间恢复到相同水平，且与非跑步者相比每周跑步里程数减少（分别为15.7英里和7.8英里；P < 0.001）。术后，78%的患者SANE活动评分良好/优秀，但特格纳评分平均下降（从5.5降至5.1）。急性撕裂的SANE活动评分更高。iHOT-12和KJOC评分的平均值分别为99和77。内镜修复的结局评分与开放修复相当，不过鉴于内镜组患者数量较少，结论有限。50岁以上患者的满意度更高（P = 0.024），尽管他们恢复跑步的可能性较小（P = 0.010）。
总体而言，患者满意度和功能良好。就现有数据而言，我们无法检测到基于患者年龄、性别、体重指数、吸烟状况、内科合并症、撕裂分级、活动水平或开放与内镜技术的功能结局评分有任何显著差异。急性撕裂的SANE活动评分更好。应提醒跑步者，腘绳肌近端修复术后他们可能无法恢复到受伤前的相同活动水平。
在为腘绳肌近端撕裂患者提供咨询时，跑步者和慢性撕裂患者应设定适当的预期。
