Surgical management of distal hamstring non-avulsion T-junction tears
ESSKA Academy. Ayuob A. 11/09/19; 286401
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Surgical management of distal hamstring non-avulsion T-junction tears

ESMA Free Papers

Topic: Sports Injury and Return to Competition Criteria

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

Introduction: T-Junction tears of distal Biceps Femoris usually result during explosive accelerating, pivotting or twisting during high-energy sporting activities. These injuries are also associated with delayed healing and chronic muscle weakness.
Objectives: Primary objective was to measure the recurrence rates and time to return to sporting activity. Secondary outcomes measured included patient satisfaction, relative isometric hamstring muscle strength, passive straight leg raise angle (PSLR), lower extremity functional scores (LEFS), Marx Sporting Activity scores (MARS), and complications at 3-months and 1-year and 2-years post-op.
Methods: A prospective study of 34 athletes with unstable injuries at T-junction of the long and short heads of Biceps femoris, all diagnosed and confirmed with MRIs. All patients were operated by one surgeon and followed up for at least 2 years.
Results: The surgical repair of these cases was met with high levels of patient satisfaction (52.9% satisfied and 38.2% very satisfied at 3 months post-op and 97.1% satisfaction at 2 years post-op). Isometric hamstring strength improved at 0 degrees (63.1 ± 7.7% Vs 93.1 ± 5.4%, p< 0.001), 15 degrees (38.9 ± 9.5% Vs 88.2 ± 8.1%, p< 0.001), 45 degrees (24.8 ± 8.3% Vs 76.8 ± 9.7%, p< 0.001), and 90 degrees (85.6 ± 5.9% Vs 96.4 ± 3.9%, p< 0.001) compared to the contralateral side at 3 months post-op. PSLR angle significantly improved at 3 months post-op (24.1 ± 7.4 vs 69.7 ± 11.7 degrees, p< 0.001). LEFS significantly improved at 3-months follow-up compared to preoperative values (27.2 ± 5.4 Vs 64.5 ± 4.5, p< 0.001). MARS showed marked improvement between 3 months to 12 months post-op (2.2 ± 2.1 Vs 10.7 ± 2.7, p< 0.001). All study patients returned to their preinjury level sporting activity. Mean time from surgical intervention to return to sporting activity was 16.4 ± 3.2 weeks (range 13 to 27 weeks). All patients were able to return to sporting activity at mean of 16.7 ± 3.6 weeks. No recurrences were seen in 2 years of follow-up.
Conclusion: Surgical management of distal Biceps Femoris tears at confluence of both heads is associated with minimal recurrences, high levels of patient satisfaction, increased muscle strength, improved functional outcome scores and early restoration to sporting activity at short-term follow-up.
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