Department of Orthopaedics and Traumatology, University of Rome 'La Sapienza', Sant'Andrea Hospital, Rome, Italy.
Centre for Sport and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom of Great Britain and Northern Ireland.
Knee Surg Sports Traumatol Arthrosc. 2024 Sep;32(9):2386-2394. doi: 10.1002/ksa.12368. Epub 2024 Jul 17.
To evaluate the mid-term clinical outcomes for the non-surgical and surgical management of acute proximal hamstring avulsions.
Sixty physically active individuals were offered surgical or non-surgical management for their proximal hamstring avulsion injuries. Distal retraction was defined as greater than 2 cm. Primary outcome measures were the Victorian Institute of sport assessment-proximal hamstring tendons (VISA-H) and functional assessment scale for acute hamstring injuries (FASH). Secondary outcome measures included palpable gap (cm), return to sport (RTS) and the ability to perform Nordic hamstring curls. Outcome variables were adjusted in regression models for gender, age, and treatment.
Thirty-one patients elected to undertake non-surgical management, and 29 chose surgery with a mean follow-up of 34.8 ± 8.7 and 34.9 ± 7.0 months, respectively. The mean VISA-H for the non-surgical and surgical groups were 87.3 ± 3.4 and 87.9 ± 4.1 (n.s.), respectively. The mean FASH for the non-surgical group was 89.3 ± 2.4 and 88 ± 3.6 for the surgical group (n.s.). This was consistent after adjusting for confounders. The mean gap for the non-surgical group was 4.5 ± 1.09 and 4.9 ± 1.19 cm for the surgical group (n.s.). No significant differences were found in the abilities to perform Nordic hamstring curls (n.s.). Both groups achieved comparable RTS rates (n.s.). On average, the non-surgical group achieved RTS at 5.5 ± 1.2 months post-injury, whereas the surgical group was at 5.7 ± 0.7 months (n.s.).
Physically active individuals with acute proximal hamstring avulsions and distal retraction of the tendon stump can be managed non-surgically, achieving similar functional levels and RTS compared to patients treated surgically.
Level III.
评估急性近端腘绳肌腱撕裂的非手术和手术治疗的中期临床结果。
对 60 名活跃的个体进行近端腘绳肌腱撕裂的手术或非手术治疗。远端回缩定义为大于 2cm。主要结局指标为维多利亚运动评估-近端腘绳肌腱（VISA-H）和急性腘绳肌损伤功能评估量表（FASH）。次要结局指标包括可触及的间隙（cm）、重返运动（RTS）和进行北欧腘绳肌卷曲的能力。对性别、年龄和治疗进行回归模型调整。
31 名患者选择非手术治疗，29 名患者选择手术治疗，平均随访 34.8±8.7 和 34.9±7.0 个月。非手术组和手术组的 VISA-H 平均值分别为 87.3±3.4 和 87.9±4.1（无统计学差异）。非手术组的 FASH 平均值为 89.3±2.4，手术组为 88±3.6（无统计学差异）。调整混杂因素后结果一致。非手术组的平均间隙为 4.5±1.09cm，手术组为 4.9±1.19cm（无统计学差异）。两组进行北欧腘绳肌卷曲的能力无显著差异（无统计学差异）。两组 RTS 率均无显著差异（无统计学差异）。非手术组平均 RTS 时间为受伤后 5.5±1.2 个月，手术组为 5.7±0.7 个月（无统计学差异）。
急性近端腘绳肌腱撕裂伴肌腱残端远端回缩的活跃个体可以进行非手术治疗，与手术治疗的患者相比，可获得相似的功能水平和 RTS。
III 级。
