Non‐surgical management of acute proximal hamstring avulsions can produce clinically acceptable results

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 32; no. 9; pp. 2386 - 2394
• Main Authors: Maffulli, Nicola, Hassan, Rifat, Poku, Daryl, Chan, Otto, Oliva, Francesco
• Format: Journal Article
• Language: English
• Published: Germany 01.09.2024
• Subjects: Adult; Athletic Injuries - surgery; avulsions; Female; hamstring; Hamstring Muscles - injuries; Hamstring Tendons - injuries; Humans; Male; non‐surgical; Return to Sport; surgical; Tendon Injuries - surgery; Treatment Outcome; Young Adult; avulsions; surgical; non‐surgical; hamstring
• ISSN: 0942-2056; 1433-7347; 1433-7347
• DOI: 10.1002/ksa.12368

Purpose To evaluate the mid‐term clinical outcomes for the non‐surgical and surgical management of acute proximal hamstring avulsions. Methods Sixty physically active individuals were offered surgical or non‐surgical management for their proximal hamstring avulsion injuries. Distal retraction was defined as greater than 2 cm. Primary outcome measures were the Victorian Institute of sport assessment‐proximal hamstring tendons (VISA‐H) and functional assessment scale for acute hamstring injuries (FASH). Secondary outcome measures included palpable gap (cm), return to sport (RTS) and the ability to perform Nordic hamstring curls. Outcome variables were adjusted in regression models for gender, age, and treatment. Results Thirty‐one patients elected to undertake non‐surgical management, and 29 chose surgery with a mean follow‐up of 34.8 ± 8.7 and 34.9 ± 7.0 months, respectively. The mean VISA‐H for the non‐surgical and surgical groups were 87.3 ± 3.4 and 87.9 ± 4.1 (n.s.), respectively. The mean FASH for the non‐surgical group was 89.3 ± 2.4 and 88 ± 3.6 for the surgical group (n.s.). This was consistent after adjusting for confounders. The mean gap for the non‐surgical group was 4.5 ± 1.09 and 4.9 ± 1.19 cm for the surgical group (n.s.). No significant differences were found in the abilities to perform Nordic hamstring curls (n.s.). Both groups achieved comparable RTS rates (n.s.). On average, the non‐surgical group achieved RTS at 5.5 ± 1.2 months post‐injury, whereas the surgical group was at 5.7 ± 0.7 months (n.s.). Conclusion Physically active individuals with acute proximal hamstring avulsions and distal retraction of the tendon stump can be managed non‐surgically, achieving similar functional levels and RTS compared to patients treated surgically. Level of Evidence Level III.