Summary

Surgical Treatment of Proximal Hamstring Avulsion Injuries offers Better Long-Term Functional Outcomes than Nonsurgical Treatment: A Matched Comparative Study with a mean follow-up of over 4-years from the PHAS cohort. A Matched Comparative Study with a

Abstract

Background

Surgical outcomes for Proximal Hamstring Avulsion Injury (PHAI) are well-documented, yet comparative analyses with non-surgical approaches remain scarce.
Hypothesis/Purpose: This study aims to compare the functional outcomes between surgical and non-surgical interventions for PHAI.
Study Design: Case-Control; Level of evidence, 3.

Method

This comparative study, conducted at a sports surgery center between January 2012 and July 2021, focused on patients with primary PHAI. The study was a retrospective analysis of prospectively collected data. Group selection involved utilizing propensity score matching to compare an arm of patients who were surgically treated (indications included patients with complete injury, partial injury with >2cm retraction, and patients who failed 6-months of surgical treatment), to another arm of patients who refused surgery. The primary outcome was evaluated using the Parisien Hamstring Avulsion Score (PHAS). The secondary outcomes included the Tegner Activity Scale (TAS), University of California, Los Angeles Scale (UCLA) scores, the rate and quality of Return to Sports (RTS), and patient satisfaction.

Results

The study included 32 patients (55.8±8.4 years) in the conservative treatment arm and 95 in the surgical treatment arm (53.4±7.7 years, p>0.05). The interval from injury to treatment was 5.7 months (SD = 9.6) for the surgical group and 2.7 months (SD = 25.9) in the non-surgical group (p>0.05). At the final follow-up (56.5 ±28.2 and 50.7±33.1 months respectively), the PHAS score was significantly higher in the surgical group (86.3±13.7) compared to the non-surgical group (69.8±15.1; p<0.0001). Higher activity scores were also observed in the surgical group for TAS and UCLA (p=0.0224 and p=0.0026, respectively). A higher percentage of the surgical group (68.4%) returned to sports compared to the non-surgical group (46.9%; p=0.0354), with a greater proportion in the surgical group returning at the same or higher level (67.7% vs. 26.7%; p=0.0069). Additionally, a higher satisfaction level was reported by patients in the surgical group (89.5%) in contrast to the non-surgical group (25%; p<0.0001). Three patients in the surgical group experienced complication (2 rerupture and 1 hyperesthesia at the pudendal nerve territories). Odds ratios indicated that patients in the surgical group were significantly more likely to achieve or exceed median scores for PHAS (OR: 6.79, p<0.001), TAS (OR: 2.29, p=0.045), and UCLA (OR: 3.63, p=0.003), as well as to RTS at any level (OR: 2.46, p=0.031) or at the pre-injury level or higher (OR: 6.04, p<0.001).

Conclusion

This study demonstrates that surgical treatment of PHAI significantly enhances long-term functional scores, including PHAS, TAS, UCLA, satisfaction, and RTS, at a mean follow-up of over 4-years compared to non-surgical treatment.
Study Design: Case-Control; Level of evidence, 3.
Keywords: Proximal Hamstring Avulsion Injury, Hip, PHAI repair, Conservative Treatment, Sports