title: Clinical and magnetic resonance imaging outcomes after surgical repair of complete proximal hamstring ruptures: does the tendon heal?
abstract: BACKGROUND
  The use of validated outcome questionnaires and magnetic resonance imaging (MRI) when assessing outcomes after surgical treatment of proximal hamstring avulsions has been limited.
  
  
  OBJECTIVE
  To comprehensively evaluate clinical, functional, and radiological outcomes in patients treated with surgical repair for complete proximal hamstring avulsions.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A retrospective review of 15 consecutive patients was performed. Outcome measures included the Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, Proximal Hamstring Injury Questionnaire, Lower Extremity Functional Scale (LEFS), Harris Hip Score (HHS), and Tegner Activity Scale (TAS). Physical examination was performed by an independent sports medicine fellow. Magnetic resonance imaging of the lower extremity was used to assess tendon healing and muscle quality after repair.
  
  
  RESULTS
  Thirteen of 15 (87%) eligible patients were available for follow-up at a mean 36.9 months (range, 27-63 months), including 8 men and 6 left-sided injuries. The average age was 44.6 years (range, 26-58 years). Twelve of 13 patients underwent surgical repair within 60 days of injury. Mean (± standard deviation) postoperative functional outcome scores were as follows: LEFS, 74.9 ± 7.8 (range, 59-80); HHS, 90.7 ± 13.9 (range, 67-100); SANE, 93.6 ± 7.5 (range, 75-100); VAS for pain, 1.3 ± 1.9 (range, 0-5); and TAS, 4.6 ± 2.3 (range, 1-7). All 11 patients who participated in sports before surgery were able to return to sport, but 45% reported a decrease in their current level of activity. Isokinetic muscle testing demonstrated that injured hamstring strength recovered up to 78% ± 6.1% (range, 74%-88%) of the contralateral side. The MRI examinations revealed that 100% of patients had a healed proximal hamstring repair, with signs of tendinopathy and mild atrophy in 3 of 12 patients.
  
  
  CONCLUSIONS
  The current findings indicate that surgical repair of complete hamstring ruptures provides reliable pain relief, good functional outcomes, high satisfaction rates, and excellent healing rates (MRI) but does not fully restore hamstring function and sports activity to preinjury levels.
authors.affiliation: Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, IL 60622, USA.
authors.forename: Jaskarndip
authors.initials: J
authors.lastname: Chahal
authors.forename: Charles A
authors.initials: CA
authors.lastname: Bush-Joseph
authors.forename: Alex
authors.initials: A
authors.lastname: Chow
authors.forename: Anthony
authors.initials: A
authors.lastname: Zelazny
authors.forename: Richard C
authors.initials: RC
authors.lastname: Mather
authors.forename: Emery C
authors.initials: EC
authors.lastname: Lin
authors.forename: Deepti
authors.initials: D
authors.lastname: Gupta
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000175:diagnosis* / Q000534:rehabilitation / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D053581:Muscle Strength Dynamometer; D018482:Muscle, Skeletal / Q000293:injuries* / Q000601:surgery*; D012189:Retrospective Studies; D012421:Rupture; D013708:Tendon Injuries / Q000175:diagnosis* / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing