Functional Outcomes of Proximal Hamstring Tendon Repair in Patients Over 40 Treated Without Postoperative Bracing

BACKGROUND: Degenerative tendon changes are common as people age, which can increase the likelihood of tendinous injuries. The outcomes of repairing hamstring tendon avulsions in patients >40 years after a rehabilitation protocol without postoperative bracing are relatively unknown.

PURPOSE: To assess the functional outcomes of patients >40 years and determine the rerupture rate after surgical repair of complete proximal hamstring tendon avulsions while following a nonbracing rehabilitation protocol.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: A total of 27 patients >40 years with acute, complete proximal hamstring avulsions underwent surgical repair between 2012 and 2022 and completed follow-up assessments. Postoperative patient-reported outcome measures (PROMs) included the Single Assessment Numeric Evaluation (SANE), Physical (PCS) and Mental (MCS) Short Form 12 (SF-12), Marx Activity Rating Scale (Marx), Lower Extremity Functional Score (LEFS), Perth Hamstring Assessment Tool (PHAT), patient satisfaction (0-10 scale), and return to sports (RTS). Surgical repair integrity was assessed with physical and ultrasound examinations.

RESULTS: A total of 27 patients-including 10 men and 17 women-and 28 hips-including 10 right-leg and 18 left-leg hamstring avulsions-were included in this study. The mean age was 55.9 ± 8.3 years, and the mean body mass index was 27.1 ± 6.5 kg/m 2 at the time of surgery. All 28 injuries were complete avulsions involving 3 hamstring tendons. The mean time from injury to surgery was 17.9 ± 12.4 days; 25 avulsions were repaired early (time to surgery <6 weeks), and 3 hamstrings were repaired delayed (6 to 8 weeks). All 28 avulsions were retracted at a mean distance of 4.9 ± 2.9 cm from the ischial tuberosity. The mean follow-up time was 67 ± 28.5 months. The mean follow-up PROMs included a SANE of 85.9 ± 18.1, SF-12 PCS of 49 ± 8.3, and SF-12 MCS of 54.7 ± 7.1, Marx of 6.3 ± 5.6, LEFS of 69.9 ± 12.7 (completed for 27 hips), PHAT of 82.1 ± 16.3 (completed for 26 hips), patient satisfaction of 9.1 ± 2, and 22 patients returned to sports (78.6%). At the last follow-up, all tendon repairs appeared intact and reinserted at the ischial tuberosity after ultrasound and physical examinations, and there were no signs of rerupture.

CONCLUSION: Surgical repair of complete proximal hamstring tendon avulsions with a nonbracing rehabilitation protocol for patients >40 years demonstrated intact repairs with no reruptures. Some patients reported pain during follow-up functional testing, but the overall results highlighted positive functional and patient-reported outcomes, high levels of satisfaction, and a high RTS rate.