Unit of Orthopeadics, Department of Clinical Sciences at Danderyds Hospital, Karolinska Institutet, Ortopedmottagningen Danderyds Sjukhus, 182 88, Stockholm, Sweden.
Danderyd University Hospital Corp, Stockholm, Sweden.
J Orthop Surg Res. 2023 Feb 16;18(1):114. doi: 10.1186/s13018-023-03582-2.
Proximal hamstring tendon avulsions (PHAs) may be treated nonoperatively or operatively. Little is known about the result of the injury, and its treatment, on the quality and function of the hamstring muscle after healing and rehabilitation. We hypothesized that the injured leg would have greater fatty infiltration and atrophy than the uninjured leg at follow-up and that these findings would correlate to muscle weakness.
In a cross-sectional cohort study, 48 patients treated for PHA, either operatively or nonoperatively, were re-examined 2-11 years post-treatment. We measured muscle strength with isokinetic strength tests, and muscle volume and fatty infiltration with MRI. Primary outcomes were hamstring muscle quality, quantified by outlining the cross-sectional area slice-by-slice, and the degree of fatty infiltration estimated using the Goutallier grading method. Secondary outcome was concentric isokinetic hamstring muscle strength measured using BioDex at 60°/sec and tendon attachment assessed on MRI. Comparisons with the outcomes of the uninjured leg were made.
The total hamstring muscle volume was on average reduced by 9% (SD ± 11%, p < 0.001) compared to that of the uninjured leg. Fatty infiltration was significantly more severe in the injured hamstrings than in the uninjured hamstrings (p < 0.001). This was also true when only analyzing operatively treated patients. The reduction in muscle volume and increase in fatty infiltration correlated significantly (r = 0.357, p = 0.013), and there was also a statistically significant correlation with muscle atrophy and reduction in isokinetic strength (r = 494, p < 0.001).
PHA injuries result in fatty infiltration and muscle atrophy and the muscle quality impairment correlates with residual muscle weakness.
腘绳肌腱近端撕脱（PHAs）可选择非手术或手术治疗。对于损伤及其治疗后愈合和康复过程对腘绳肌质量和功能的影响，我们知之甚少。我们假设，与未受伤的腿相比，受伤的腿在随访时会有更大的脂肪浸润和萎缩，并且这些发现与肌肉无力相关。
在一项横断面队列研究中，对 48 例接受 PHAs 治疗的患者（手术或非手术治疗）进行了回顾性研究，这些患者在治疗后 2-11 年接受了随访。我们使用等速力量测试测量肌肉力量，使用 MRI 测量肌肉体积和脂肪浸润。主要结局是通过逐一切面描绘横截面面积来量化的腘绳肌质量，以及使用 Goutallier 分级法估计的脂肪浸润程度。次要结局是使用 BioDex 在 60°/秒时测量的等速向心腘绳肌力量和 MRI 上评估的肌腱附着。与未受伤腿的结果进行了比较。
与未受伤的腿相比，总腘绳肌体积平均减少了 9%（SD±11%，p<0.001）。受伤的腘绳肌的脂肪浸润明显比未受伤的腘绳肌严重（p<0.001）。当仅分析手术治疗的患者时也是如此。肌肉体积减少和脂肪浸润增加呈显著相关（r=0.357，p=0.013），并且与肌肉萎缩和等速力量下降也存在统计学显著相关性（r=494，p<0.001）。
PHAs 损伤会导致脂肪浸润和肌肉萎缩，肌肉质量的损害与残余肌肉无力相关。
