title: Functional outcome after repair of proximal hamstring avulsions.
abstract: BACKGROUND
  Rupture of the proximal origin of the hamstrings leads to pain, weakness, and a debilitating decrease in physical activity. Repair of these injuries should be based on the expectation that these deficits can be addressed. The goal of this study was to objectively evaluate the efficacy of repair of proximal hamstring avulsions.
  
  
  METHODS
  Thirty-four patients were identified retrospectively to have a complete rupture of the proximal origin of the hamstrings based on the presence of a bowstring sign and the results of magnetic resonance imaging (MRI).Patients were contacted for follow-up evaluation to fill out a subjective questionnaire, to undergo functional testing, and to undergo isokinetic testing on a Cybex dynamometer. Twenty-three patients were evaluated.
  
  
  RESULTS
  There were nine acute and fourteen chronic repairs, and the average period of follow-up was 43.3 months. Twenty-one of twenty-three patients reported returning to activity at an average of 95% of their pre-injury activity level at an average of 9.8 months. Eighteen patients reported excellent results; four, good results; and one, fair results. Hamstring strength was an average of 93% and 90% of that in the uninvolved limb at 240° per second and 180° per second, respectively. The hamstrings-to-quadriceps ratio was 56% for 240° per second and 48% at 180° per second. Hamstring endurance was an average of 81% and 91% of the nonoperative limb at 240° per second and 180° per second, respectively. Postoperative quadriceps strength and endurance were positively correlated with return to pre-injury level of activity (r = 0.6, p < 0.05; and r = 0.6, p < 0.05) and negatively correlated with time to return to sport (r = -0.5, p < 0.05; and r = -0.5, p < 0.05). There was no significant effect associated with age or time from injury.
  
  
  CONCLUSIONS
  Repair of a symptomatic and displaced ruptured proximal hamstring tendon yields good subjective and objective functional results with minimal complications. Overall, patients are satisfied with surgical repair and experience return of functional activity with minimal postoperative weakness.
authors: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. patrickbirmingham@gmail.edu
authors: Patrick
authors: P
authors: Birmingham
authors: Mark
authors: M
authors: Muller
authors: Thomas
authors: T
authors: Wickiewicz
authors: John
authors: J
authors: Cavanaugh
authors: Scott
authors: S
authors: Rodeo
authors: Russell
authors: R
authors: Warren
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001265:Athletic Injuries / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018763:Muscle Fatigue / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D017060:Patient Satisfaction; D052097:Quadriceps Muscle / Q000503:physiopathology; D020127:Recovery of Function / Q000502:physiology*; D012421:Rupture / Q000503:physiopathology / Q000601:surgery; D012737:Sex Factors; D013708:Tendon Injuries / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D013848:Thigh; D016896:Treatment Outcome; D055815:Young Adult