title: Complete Avulsion of the Proximal Hamstring Insertion: Functional Outcomes After Nonsurgical Treatment.
abstract: BACKGROUND
  Complete proximal hamstring avulsions are an uncommon injury. The purpose of this study was to determine the functional and subjective outcomes following nonsurgical management of complete proximal hamstring avulsions.
  
  
  METHODS
  We retrospectively identified nineteen patients (mean age, fifty-nine years; range, forty-four to seventy-three years) at one institution who presented with complete avulsions of the proximal hamstring insertion, confirmed on magnetic resonance imaging, and had nonsurgical treatment. Results on the Lower Extremity Functional Scale (LEFS) and Short Form-12 version 2 (SF-12v2) questionnaires as well as functional and isometric testing (with a handheld dynamometer) were collected. Seventeen patients completed the questionnaires. Ten patients underwent functional testing. The average follow-up period was thirty-one months (range, eight to 156 months).
  
  
  RESULTS
  The mean score on the LEFS was 70.2 of a maximum of 80 points. The mean SF-12v2 physical and mental component summary scores were 52.5 and 54.1, respectively. Hamstring strength at 45° and 90° of flexion was an average of 62% (p = 0.09) and 66% (p = 0.07), respectively, of that of the uninvolved limb. The single-leg hop test revealed an average decline of 2.2% (p = 0.93) compared with the uninvolved limb. Twelve of the seventeen patients were able to return to their previous sporting activities.
  
  
  CONCLUSIONS
  Nonsurgical management after a complete proximal hamstring avulsion yields noticeable subjective and strength deficits.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Tufts Medical Center, 800 Washington Street, Box 306, Boston, MA 02111. E-mail address: khofmann@tuftsmedicalcenter.org.
authors.forename: Kurt J
authors.initials: KJ
authors.lastname: Hofmann
authors.affiliation: Orthopaedic & Sports Physical Therapy, 260 Tremont Street, Boston, MA 02112. E-mail address: apaggi@tuftsmedicalcenter.org.
authors.forename: Adam
authors.initials: A
authors.lastname: Paggi
authors.affiliation: Jump Start Physical Therapy, 1 HF Brown Way, Natick, MA 01760. E-mail address: dconnors@jstartpt.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Connors
authors.affiliation: Boston Sports and Shoulder Center, 830 Boylston Street, Suite 107, Chestnut Hill, MA 02167. E-mail address: drsuzanne4@gmail.com.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000293:injuries*; D020127:Recovery of Function; D012189:Retrospective Studies; D012421:Rupture; D011795:Surveys and Questionnaires; D013708:Tendon Injuries / Q000628:therapy*; D013848:Thigh / Q000293:injuries*; D016896:Treatment Outcome