title: Self-reported and performance-based functional outcomes after surgical repair of proximal hamstring avulsions.
abstract: BACKGROUND
  Because a proximal hamstring avulsion results in residual loss of function, surgical repair is recommended. Few studies have investigated postoperative function with validated outcomes.
  
  
  OBJECTIVE
  To examine lower extremity function after surgical repair of proximal hamstring avulsions using validated self-reported and performance-based functional outcomes.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Operative records from 2006 to 2010 were retrospectively reviewed in 3 hospitals. A total of 39 patients who had undergone surgical repair of a proximal hamstring avulsion were identified, and 36 met the inclusion criteria. Thirty-one patients completed questionnaires with demographic background data and quality of life-related questions: the Lower Extremity Functional Scale (LEFS) and the Proximal Hamstring Injury Questionnaire (PHIQ). Thirty patients were evaluated using a Biodex dynamometer for isokinetic quadriceps and hamstring strength measurements at a velocity of 60 deg/s, and 27 patients performed 4 single-legged hop tests.
  
  
  RESULTS
  Twenty-eight repairs were acute (<4 weeks), and 3 were chronic. There were complete ruptures of all 3 tendons in 17 (55%) cases. The mean follow-up was 30 months. Most patients experienced little or no pain or limitations during activities of daily living. The mean LEFS score was 89%, and 29 (94%) of the 31 patients were satisfied with the result after surgery. Eighteen (58%) of the 31 patients had returned to their preinjury activity level. Significant differences in the mean hamstring strength (peak torque) (P < .001) and single-legged hop test (P = .01) between the uninvolved and involved leg were found. Twenty-two (71%) of the 31 patients did not fully trust their operated leg during physical activities and feared sustaining a hamstring injury. Return to activity significantly correlated with the single-legged hop test, the LEFS score, and the questions regarding trust and fear.
  
  
  CONCLUSIONS
  In this study, using both validated self-reported and performance-based outcome measures after surgical repair of proximal hamstring avulsions, minor pain and limitations to activities of daily living were seen. Isokinetic hamstring strength in the operated leg was significantly lower compared with the nonoperated leg, and a majority of the patients did not trust the operated leg completely during physical activity.
authors.affiliation: Heléne Engberg Skaara,Oslo University Hospital, Ullevål Hospital, Division of Surgery and Clinical Neuroscience, Building 72, 2nd Floor, PO Box 4950, Nydalen, Oslo, Norway, N-0424. uxhees@ous-hf.no.
authors.forename: Heléne Engberg
authors.initials: HE
authors.lastname: Skaara
authors.forename: Håvard
authors.initials: H
authors.lastname: Moksnes
authors.forename: Frede
authors.initials: F
authors.lastname: Frihagen
authors.forename: Britt
authors.initials: B
authors.lastname: Stuge
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000293:injuries* / Q000502:physiology / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000523:psychology; D011795:Surveys and Questionnaires; D013848:Thigh / Q000293:injuries* / Q000502:physiology / Q000601:surgery
keywords: avulsion; complete tear; function; hamstring injury; surgical repair