Summary

Surgical repair of PHAI is associated with improved long-term functional prognosis of patients. The PHAS score is expected to increase over time, until 8 years postoperatively.

Abstract

Background

Proximal hamstring Avulsion Injuries (PHAI) are debilitating injuries that can affect the long-term quality of life.

Purpose

To evaluate the long-term functional results of PHAI repair and determine the rate of patient satisfaction and the quality of their return to sport at the latest follow-up.
Study Design: Prospective cohort study; Level of evidence, 2.

Methods

This was a prospective cohort study conducted from January 2002 to May 2015. The study targeted all patients undergoing PHAI repair during this timeframe ensuring a minimum follow-up of 8-years. The primary outcome measure used was the Parisian Hamstring Avulsion Score (PHAS). Secondary outcome measures included the UCLA activity scale and the Tegner Activity Scale. A satisfaction survey was conducted, the complication rate was assessed, and both the rate and quality of return to sport were analyzed.

Results

The study involved 151 patients with a mean age of 44.4 years (SD=11.3) and a mean follow-up duration of 124.3 months (SD=30.8). The PHAS at the last follow-up was 87.5 (SD=14.9). This score was significantly impacted by the effect of time (ATS = 65.40497, df = 4.050724, p < 0.0002), with post hoc analysis showing lower median scores at 2 years compared to 6 and 8 years (p = 0.04 and p = 0.001, respectively) and at 4 years compared to 6 and 8 years (p = 0.001 and p = 0.01, respectively). The UCLA Activity scale improved significantly from a preoperative mean of 3.1 (SD=1.3) to 7.5 (SD=2.5) at the final follow-up (P < .001). Similarly, Tegner’s Activity Level Score increased from a mean of 1.8 (SD=1.3) before surgery to 4.5 (SD=2.1) at the final follow-up (P < .001). Satisfaction was reported by 87.8% of patients. Reruptures were recorded in 11 patients, accounting for 7.3% of the cases. Eighty percent of the patients returned to the same type of sport postoperatively as before the injury, with 43.5% reaching the same preoperative level.

Conclusion

Surgical repair of PHAI is associated with improved long-term functional prognosis of patients. The PHAS score is expected to increase over time, until 8 years postoperatively.