Summary

Revision PHAI repair is associated with in lower functional scores and nearly 8 times the risk of rerupture compared to primary surgery. Furthermore, it carries a higher rate of complications.

Abstract

Background

PHAI repair are increasing with the growing frequency of this pathology. That is why rerupture are increasingly encountered with rare studies reporting this outcome
Hypothesis/purpose: To compare the functional outcomes of revision versus primary PHAI surgery as measured by the Parisian Hamstring Avulsion Score (PHAS), and to compare other outcomes scores, return to sports (RTS) status, and complication rate.
Study design: Case – control study.

Methods

This single-center, matched case-control study was conducted from 2009 to 2022 at a center specializing in sports surgery. It included adults over 18 who underwent revision or primary PHAI repair and had a minimum one-year follow-up. The study involved matching revision surgery patients to primary surgery patients at a 1:4 ratio based on age, gender, Tegner Activity Scale (TAS) prior to injury, type of rupture, and follow-up duration. Surgical treatment was indicated for complete PHAI, partial tendon avulsion with over 2cm of retraction, or non-response to six months of conservative treatment. Outcomes measured were the Parisian Hamstring Avulsion Score (PHAS), complication rate including rerupture, TAS, UCLA activity score and patient satisfaction.

Results

The study included 160 patients, with 128 in the primary group and 32 in the revision group. The mean age for the primary group was 48.6 years (SD=9.4) and for the revision group, it was 48.8 years (SD=9.4); both groups had similar follow-up periods of 45.5 months (SD=39.5) for the primary and 51.0 months (SD=46.5) for the revision. Allograft usage was substantially higher in the revision group at 62.5% (20/32) compared to 90.6% (116/128) in the primary group (p=0.0003). At the final follow-up, PHAS scores were lower in the revision group with an average of 85.0 (IQR: 64.5, 90.0) versus 91.3 (IQR=77.8, 97.0) in the primary group (p=0.0060). The rerupture rate also differed significantly, standing at 31.3% (10 out of 32) in the revision group compared to only 3.9% (5 out of 128) in the primary group, with the Kaplan-Meier and Cox regression analysis confirming a higher risk of rerupture, quantified as 8.19 times more likely (95% CI: 2.76; 24.3, p<0.0001). There was more complications in the revision group (21.9%) as compared to the primary group (7%, p=0.02). Tegner Activity Scale and UCLA scores did not show significant differences (p>0.05). Rates of return to sport were similarly comparable across the groups (p>0.05). Pain reported as no or mild affected 72.6% (90/124) of the primary group, but only 52.0% (13/25) of the revision group, marking a significant difference (p=0.0234).

Conclusion

Revision PHAI repair is associated with in lower functional scores and nearly 8 times the risk of rerupture compared to primary surgery. Furthermore, it carries a higher rate of complications.