A RANDOMIZED CONTROLLED TRIAL ASSESSING A BRACE-FREE AND ACCELERATED WEIGHT-BEARING PROTOCOL AFTER SURGICAL REPAIR OF ACUTE PROXIMAL HAMSTRING TENDON AVULSIONS

Abstract

INTRODUCTION & AIMS Proximal hamstring tendon avulsion from the ischial tuberosity is a significant injury, with surgical repair advocated. After surgery, limited data exists regarding the optimal rehabilitation regime with extensive variation in published protocols. This study investigated patient outcomes following a traditionally conservative (CR) versus accelerated (AR) rehabilitation regimen after proximal hamstring tendon repair. METHODS This prospective randomized controlled trial (RCT) allocated 50 patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR=25) or an accelerated, unbraced regime, that permitted full weight-bearing as tolerated (AR=25). Patients were evaluated pre-operatively and at 3, 6 and 12 months post-surgery, via patient-reported outcome measures (PROMs) including the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT) and 12-item Short Form Health Survey (SF-12). The single (SHD), triple (THD) and triple crossover (TCHD) hop tests were assessed at 6 and 12 months, as was peak isometric hamstring strength and peak isokinetic knee extensor and flexor torque. RESULTS All PROMs improved (p>0.05) and, while the AR group reported a significantly better Physical Component Score for the SF-12 at 3 months (p=0.022), as well as a lower severity of hamstring pain at 12 months (p=0.032), there were no other group differences. Peak isometric hamstrings strength and peak isokinetic quadriceps and hamstrings torque symmetry were all comparable between groups (p>0.05). While the AR group demonstrated significantly better (p=0.009) limb symmetry for the THD at 6 months, no other hop test differences were seen between groups. Three re-injuries have been observed (CR=2, AR=1). CONCLUSION After proximal hamstring repair surgery, post-operative outcomes following an accelerated rehabilitation regimen were largely comparable to a traditionally conservative