Simon Zilko

Avulsion of the proximal hamstring tendons is an uncommon injury. To date, few studies have prospectively evaluated outcomes of surgical repair. The aim of the present study is to review the functional outcomes of surgical repair of proximal hamstring tendon avulsions. This is a prospective series of 96 consecutive proximal hamstring surgical repairs in 94 patients, with a median age of 50 years and median follow-up of 33 months (range 12-58). Functional outcomes were assessed using the Perth Hamstring Assessment Tool (PHAT)-a validated scoring system for proximal hamstring injuries. Significant improvements in functional outcomes were seen across all patients at 1-year follow-up. There was a mean PHAT score improvement of 34.7 points at the 1-year follow-up (p < 0.001, 95% CI 29.9-39.5). The SF-12 PCS scores showed a significant improvement at 1-year follow-up of 13.8 points (p < 0.001, 95% CI 10.7-16.9). These were maintained at final follow-up. Acute repairs had significantly higher improvement in PHAT score with acute patients improving a mean of 38.6 points (p < 0.001, 95% CI 32.0-44.3) and chronic patients only improving by a mean of 25.3 points (p < 0.001, 95% CI 18.2-33.3) at final follow-up. This study establishes that surgical repair of proximal hamstring tendon ruptures leads to improved patient outcomes, in both acute and chronic repairs. Early surgical repair, however, achieves superior outcomes to late repair. These results suggest that surgeons should be operating on proximal hamstring avulsions, and preferably in the acute stage. II.

The purpose of the present study was to validate a new scoring system for proximal hamstring injury-the Perth Hamstring Assessment Tool (PHAT). This is a prospective series of 74 consecutive proximal hamstring surgical repairs in 72 patients, with a median age of 50.5 years (range 16-74). Patients completed the PHAT, SF12 Health Survey and Lower Extremity Functional Scale (LEFS). The scoring system was validated by calculating its internal consistency, reproducibility, reliability and sensitivity to change. Construct validity was evaluated using Pearson's correlation analysis to examine the strength of association between the PHAT, LEFS and SF-12 scores. The PHAT showed high completion rate (100 %), high internal consistency (Cronbach's alpha 0.80), high reproducibility (ICC 0.84) and high sensitivity to change. There was moderate correlation with the LEFS and low correlation with the Physical Component Score of the SF-12. This study has validated the PHAT as an assessment tool for proximal hamstring tendon injuries. The new questionnaire provides a measure of outcome that is reliable and sensitive to clinically important change. This simple questionnaire provides the clinician with a quick and practical tool for assessing patients with proximal hamstring injuries: to assess pre-operative disability and monitor recovery post-operatively. II.

This investigation looked at functional outcomes, following a novel technique of surgical repair using table staples. Patients underwent surgery for proximal hamstring rupture with table staples used to hold the tendon reapproximated to the ischial tuberosity. Functional outcomes following surgery were assessed. We also used a combined outcome assessment measure: the Perth Hamstring Assessment Tool (PHAT). A total of 56 patients with a mean age of 51 (range 15–71) underwent surgery. The mean follow-up duration was 26 months (range 8–59 months). A large proportion of patients (21/56, 37.5%) required reoperation for removal of the staple. Patients that did not require removal of the table staple did well postoperatively, with low pain scores (0.8–2 out of 10) and good levels of return to sport or running (75.8%). Those that required removal of the staple had a significantly lower PHAT score prior to removal, 47.8, but this improved markedly once the staple was removed, with a mean of ...