Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Mid-term Follow-up

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Objectives: Although surgical outcomes of complete hamstring avulsions are well established, the literature evaluating partial proximal hamstring repair is limited to a single study of 17 patients at short-term follow-up. Therefore, assessment of postsurgical outcomes in active patients after primary repair of acute and chronic partial proximal hamstring tears was performed. Methods: Thirty-seven patients with partial tears of the proximal hamstring origin treated with surgical fixation by a single surgeon were reviewed at 2-year minimum follow-up. All patients failed a minimum of 6 months of initial nonoperative treatment. Patient-reported outcome scores included Lower Extremity Functional Score (LEFS), Marx activity rating scale, custom LEFS and Marx scales, and total proximal hamstring score. Results: Nine male and 25 female (total=37) patients with an average age of 46.4 years (range=16-65) were reviewed at average 6.6 year (range=2-12.5) follow-up. Average postoperative LEFS was 96 (range=79-100) with custom LEFS being 91 (range=39-100). The mean Marx score was 12.7 (range=4-16). Marx custom score demonstrated no disability with activities of daily living. Mean total proximal hamstring score was 95 (range=69-100). No difference in any outcome measures were seen when comparing acute vs. chronic repairs. No patient underwent future hamstring surgery. No patients reported symptoms of numbness in the operative extremity at rest while 1 patient had a superficial stitch abscess treated with antibiotics alone. All (37/37) were satisfied with surgery, 83.7% reported they could participate in strenuous activity, and 94.6% estimated their strength to be >75% while 62.2% to be 100% of their contralateral side. Conclusion: Both acute and chronic anatomic surgical repair of partial proximal hamstring avulsions leads to successful functional outcomes, a high rate of return to athletic activity, and low complication rate at 6.6-year follow-up. Non-operative treatments should first be attempted including physical therapy with platelet rich plasma (PRP) injections as a possible adjunct.