Surgical Technique Improves Hamstring Rupture Outcomes

Chronic proximal hamstring ruptures that are repaired surgically with a reconstruction technique that involves an Achilles allograft and interference screw fixation can result in patients' return to full activity, according to a report on 26 patients.

Hamstring strains account for 25%-30% of all muscle strains, and–often after a lengthy convalescence–recovery is complete and uneventful. Complete rupture of the proximal hamstring tendon, however, is more serious and often requires surgical treatment, whether the rupture is acute or chronic. Although two prior studies on reconstructions in chronic injuries have shown “less than optimal results,” the investigators, Dr. Greg J. Folsom and Dr. Christopher M. Larson, who are orthopedic surgeons in Eden Prairie, Minn., note that prior published reports on chronic ruptures are retrospective and have small sample sizes because this injury is rare.

In this study, 26 patients with a mean age of 44 years (range, 16-58 years) were randomized as having an acute or chronic rupture.

A total of five patients had ruptures that had occurred 4-116 months prior to surgery, and thus qualified as chronic ruptures.

At follow-up, some of those patients had limitations, but all reported being more active and feeling stronger than before surgery. Three of the patients in the chronic group had a complete recovery and returned to athletic endeavors. Of those, two were classified as recreational athletes (defined as engaging in a highly physical activity at least once a week), and one was classified as an elite athlete.

One patient returned to sporting activities but was unable to jog long distances. The final patient complained of pain with vigorous activity and reported being unable to jog.

All patients reported satisfaction with the results, but one indicated the intention to decline the surgery a second time (Am. J. Sports Med. 2007 [Epub doi:10.1177/0363546507312167]).

The mean time of follow-up in the chronic patients was 17 months (range, 6-33 months).

In the group of 21 patients who underwent surgery acutely (defined as within 4 weeks of the injury), 9 patients returned to full activity and 15 returned to sports activity. Five patients did not return to sporting activity because of their injury, and one patient was lost to follow-up.

Four of the acute surgery patients reported pain with activity, six reported muscle spasms, one reported poor leg control, and one reported that the leg was giving way.

Mean follow-up in the acute group was 14 months (range, 5-43 months).

No adverse events occurred in the chronic-rupture group, but three major adverse events occurred in the acute group. One patient fell 4 months after surgery and reinjured the hamstring, one developed a complex regional pain syndrome with frequent spasms, and one developed a deep infection.

Chronic proximal hamstring ruptures that are repaired surgically with a reconstruction technique that involves an Achilles allograft and interference screw fixation can result in patients' return to full activity, according to a report on 26 patients.

Hamstring strains account for 25%-30% of all muscle strains, and–often after a lengthy convalescence–recovery is complete and uneventful. Complete rupture of the proximal hamstring tendon, however, is more serious and often requires surgical treatment, whether the rupture is acute or chronic. Although two prior studies on reconstructions in chronic injuries have shown “less than optimal results,” the investigators, Dr. Greg J. Folsom and Dr. Christopher M. Larson, who are orthopedic surgeons in Eden Prairie, Minn., note that prior published reports on chronic ruptures are retrospective and have small sample sizes because this injury is rare.

In this study, 26 patients with a mean age of 44 years (range, 16-58 years) were randomized as having an acute or chronic rupture.

A total of five patients had ruptures that had occurred 4-116 months prior to surgery, and thus qualified as chronic ruptures.

At follow-up, some of those patients had limitations, but all reported being more active and feeling stronger than before surgery. Three of the patients in the chronic group had a complete recovery and returned to athletic endeavors. Of those, two were classified as recreational athletes (defined as engaging in a highly physical activity at least once a week), and one was classified as an elite athlete.

One patient returned to sporting activities but was unable to jog long distances. The final patient complained of pain with vigorous activity and reported being unable to jog.

All patients reported satisfaction with the results, but one indicated the intention to decline the surgery a second time (Am. J. Sports Med. 2007 [Epub doi:10.1177/0363546507312167]).

The mean time of follow-up in the chronic patients was 17 months (range, 6-33 months).

In the group of 21 patients who underwent surgery acutely (defined as within 4 weeks of the injury), 9 patients returned to full activity and 15 returned to sports activity. Five patients did not return to sporting activity because of their injury, and one patient was lost to follow-up.

Four of the acute surgery patients reported pain with activity, six reported muscle spasms, one reported poor leg control, and one reported that the leg was giving way.

Mean follow-up in the acute group was 14 months (range, 5-43 months).

No adverse events occurred in the chronic-rupture group, but three major adverse events occurred in the acute group. One patient fell 4 months after surgery and reinjured the hamstring, one developed a complex regional pain syndrome with frequent spasms, and one developed a deep infection.

Chronic proximal hamstring ruptures that are repaired surgically with a reconstruction technique that involves an Achilles allograft and interference screw fixation can result in patients' return to full activity, according to a report on 26 patients.

Hamstring strains account for 25%-30% of all muscle strains, and–often after a lengthy convalescence–recovery is complete and uneventful. Complete rupture of the proximal hamstring tendon, however, is more serious and often requires surgical treatment, whether the rupture is acute or chronic. Although two prior studies on reconstructions in chronic injuries have shown “less than optimal results,” the investigators, Dr. Greg J. Folsom and Dr. Christopher M. Larson, who are orthopedic surgeons in Eden Prairie, Minn., note that prior published reports on chronic ruptures are retrospective and have small sample sizes because this injury is rare.

In this study, 26 patients with a mean age of 44 years (range, 16-58 years) were randomized as having an acute or chronic rupture.

A total of five patients had ruptures that had occurred 4-116 months prior to surgery, and thus qualified as chronic ruptures.

At follow-up, some of those patients had limitations, but all reported being more active and feeling stronger than before surgery. Three of the patients in the chronic group had a complete recovery and returned to athletic endeavors. Of those, two were classified as recreational athletes (defined as engaging in a highly physical activity at least once a week), and one was classified as an elite athlete.

One patient returned to sporting activities but was unable to jog long distances. The final patient complained of pain with vigorous activity and reported being unable to jog.

All patients reported satisfaction with the results, but one indicated the intention to decline the surgery a second time (Am. J. Sports Med. 2007 [Epub doi:10.1177/0363546507312167]).

The mean time of follow-up in the chronic patients was 17 months (range, 6-33 months).

In the group of 21 patients who underwent surgery acutely (defined as within 4 weeks of the injury), 9 patients returned to full activity and 15 returned to sports activity. Five patients did not return to sporting activity because of their injury, and one patient was lost to follow-up.

Four of the acute surgery patients reported pain with activity, six reported muscle spasms, one reported poor leg control, and one reported that the leg was giving way.

Mean follow-up in the acute group was 14 months (range, 5-43 months).

No adverse events occurred in the chronic-rupture group, but three major adverse events occurred in the acute group. One patient fell 4 months after surgery and reinjured the hamstring, one developed a complex regional pain syndrome with frequent spasms, and one developed a deep infection.