Surgical management of chronic incomplete avulsion injuries of the proximal hamstrings
ESSKA Academy. Ayuob A. 11/08/19; 284453; epESMA-54 Topic: B4 - Direct tendon repair
Mr. Atif Ayuob
Mr. Atif Ayuob
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Surgical management of chronic incomplete avulsion injuries of the proximal hamstrings

ePoster - epESMA-54

Topic: Sports Performance and Recover

Ayuob A., Kayani B., Haddad F.
University College London Hospital, Trauma and Orthopaedics, London, United Kingdom

Introduction: Incomplete avulsion injuries at the proximal hamstrings can be very debilitating as they are associated with slow healing, a chronic history, distal neurological deficits and persistent strength loss.
Objectives: To assess pre-determined outcomes of patients that underwent surgical repair of chronic tears followed for two years post-operatively.
Methods: 41 patients with chronic incomplete avulsion injuries at the proximal hamstrings were followed up for atleast 2 years after surgery. All injuries were confirmed on MRI(s) and all surgeries were performed by the senior author using a standard technique. Study outcomes including patient satisfaction, hamstring muscle strength, passive straight leg raise (PSLR) angle, lower extremity function scale (LEFS), Marx Sporting (MARS) activity scores and post-op complications were measured at pre-op, 3-month, 1-year and 2 year post-op.
Aims: Primary aim to assess recurrence after 2-year follow-up. Secondary aim to assess patient satisfaction, hamstring strength, hamstring flexibility and functional outcome scores.
Results: 92.7% patients were satisfied with surgical outcome at 3-months follow-up. Mean patient isometric hamstring strength (relative to contralateral limb) increased considerably in first three months after surgery at 0 degrees (40.4 ± 8.8% vs 84.9 ± 10.9%, p< 0.001), 15 degrees (44.2 ± 11.1% vs 89.6 ± 7.6%, p< 0.001) and 45 degrees (66.4 ± 9.0% vs 94.1 ± 5.1%, p< 0.001). Mean passive straight leg raise (PSLR) angle of the injured limb improved in 3 months after surgery from 45.4 ± 11.9 degrees to 71.2 ± 13.5 degrees (p< 0.001). Mean LEFS scores at 3 months post-op improved from 48.4 ± 5.2 to 70.8 ± 5.1 (p< 0.001), while mean Marx sporting (MARS) activity score showed significant improvement between 3 months to 12 months post-op (2.6 ± 2.8 Vs 9.4, p< 0.001). Mean interval between surgery and return to sporting activity was 22.2 ± 6.7 weeks and all sporting patients returned to their pre-injury level of sporting function. 1 patient developed complex regional pain syndrome which improved with analgesia and physiotherapy. No patients developed recurrent tears within 2 years follow-up.
Conclusion: Surgical repair of chronic incomplete proximal hamstring avulsions are associated with high levels of patient satisfaction, increased muscle strength, improved functional outcome scores, early restoration to pre-injury level of function and low risk of complications at short-term follow-up.
Surgical management of chronic incomplete avulsion injuries of the proximal hamstrings

ePoster - epESMA-54

Topic: Sports Performance and Recover

Ayuob A., Kayani B., Haddad F.
University College London Hospital, Trauma and Orthopaedics, London, United Kingdom

Introduction: Incomplete avulsion injuries at the proximal hamstrings can be very debilitating as they are associated with slow healing, a chronic history, distal neurological deficits and persistent strength loss.
Objectives: To assess pre-determined outcomes of patients that underwent surgical repair of chronic tears followed for two years post-operatively.
Methods: 41 patients with chronic incomplete avulsion injuries at the proximal hamstrings were followed up for atleast 2 years after surgery. All injuries were confirmed on MRI(s) and all surgeries were performed by the senior author using a standard technique. Study outcomes including patient satisfaction, hamstring muscle strength, passive straight leg raise (PSLR) angle, lower extremity function scale (LEFS), Marx Sporting (MARS) activity scores and post-op complications were measured at pre-op, 3-month, 1-year and 2 year post-op.
Aims: Primary aim to assess recurrence after 2-year follow-up. Secondary aim to assess patient satisfaction, hamstring strength, hamstring flexibility and functional outcome scores.
Results: 92.7% patients were satisfied with surgical outcome at 3-months follow-up. Mean patient isometric hamstring strength (relative to contralateral limb) increased considerably in first three months after surgery at 0 degrees (40.4 ± 8.8% vs 84.9 ± 10.9%, p< 0.001), 15 degrees (44.2 ± 11.1% vs 89.6 ± 7.6%, p< 0.001) and 45 degrees (66.4 ± 9.0% vs 94.1 ± 5.1%, p< 0.001). Mean passive straight leg raise (PSLR) angle of the injured limb improved in 3 months after surgery from 45.4 ± 11.9 degrees to 71.2 ± 13.5 degrees (p< 0.001). Mean LEFS scores at 3 months post-op improved from 48.4 ± 5.2 to 70.8 ± 5.1 (p< 0.001), while mean Marx sporting (MARS) activity score showed significant improvement between 3 months to 12 months post-op (2.6 ± 2.8 Vs 9.4, p< 0.001). Mean interval between surgery and return to sporting activity was 22.2 ± 6.7 weeks and all sporting patients returned to their pre-injury level of sporting function. 1 patient developed complex regional pain syndrome which improved with analgesia and physiotherapy. No patients developed recurrent tears within 2 years follow-up.
Conclusion: Surgical repair of chronic incomplete proximal hamstring avulsions are associated with high levels of patient satisfaction, increased muscle strength, improved functional outcome scores, early restoration to pre-injury level of function and low risk of complications at short-term follow-up.
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