title: Operative management of partial-thickness tears of the proximal hamstring muscles in athletes.
abstract: BACKGROUND
  Partial tears of the hamstring muscle origin represent a challenging clinical problem to the patient and orthopaedic surgeon. Although nonoperative treatment is frequently met with limited success, there is a paucity of data on the efficacy of surgical management for partial proximal hamstring tears in the active and athletic population.
  
  
  OBJECTIVE
  To evaluate the results of an anatomic repair for partial tears of the hamstring muscle origin in athletes.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The records of 17 patients with partial tears of the proximal hamstring origin were reviewed after institutional review board approval was obtained. All patients were treated with open debridement and primary tendon repair after failure of at least 6 months of nonoperative therapy. Clinical and operative records, radiographs, and magnetic resonance images were reviewed for all patients. A patient-reported outcomes survey was completed by 14 patients that included the Lower Extremity Functional Score (LEFS), Marx activity rating scale, custom LEFS and Marx scales, and subjective patient satisfaction scores. Early and late postoperative complications were recorded.
  
  
  RESULTS
  There were 3 male and 14 female patients; their average age was 43 years (range, 19-64 years) and average follow-up was 32 months (range, 12-51 months). There were 2 collegiate athletes (field hockey, track), 14 amateur athletes (distance running, waterskiing, tennis), and a professional bodybuilder. Postoperative LEFS was 73.3 ± 9.9 (range, 50-80) and custom LEFS was 66.7 ± 17.0 (range, 37-80) of a maximum 80 points. The most commonly reported difficulty was with prolonged sitting and explosive direction change while running. The average Marx score was 6.5 ± 5.3 (range, 0-16) of a maximum 16, correlating with a greater return to recreational running activities in this patient cohort than regular participation in pivoting or cutting sports. Marx custom scores were 20 of a maximum 20 in all patients, demonstrating no disability in the operative extremity with activities of daily living. No patient underwent a subsequent surgery. One patient was not satisfied with the result and reported persistent symptoms during competitive distance running. All patients were able to return to their preoperative level of activity after surgery.
  
  
  CONCLUSIONS
  Anatomic surgical treatment of partial proximal hamstring avulsions can lead to satisfactory functional outcomes, a high rate of return to athletic activity, and low complication rate. This procedure should be reserved for patients who have failed an extended course of nonoperative treatment, and the proximity of the sciatic nerve mandates a careful assessment of the risk-benefit ratio before surgery is undertaken.
authors.affiliation: Harbour Sports Medicine, Wardell Orthopaedics, Suffolk, VA, USA.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Bowman
authors.forename: Steven B
authors.initials: SB
authors.lastname: Cohen
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D012420:Running / Q000502:physiology; D011795:Surveys and Questionnaires; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013710:Tendons / Q000601:surgery; D013848:Thigh; D055815:Young Adult
keywords: hamstring avulsion; hamstring syndrome; ischial tuberosity; sciatic nerve; tendinopathy