Pre-operative activity level and a sport or recreation injury mechanism are associated with 2-year clinical outcome after proximal hamstring tendon repair

Surgical repair of proximal hamstring tendon ruptures has demonstrated encouraging outcomes and satisfaction rates, superior to non-operative management. This study sought to investigate injury, surgical and post-operative factors associated with clinical outcome and satisfaction 2-years after proximal hamstring tendon repair of acute tendon injuries. This study included 59 patients undergoing proximal hamstring repair for acute tendon ruptures. Clinical assessment pre-operatively and 2-years post-operatively included the Perth Hamstring Assessment Tool (PHAT), Lower Extremity Functional Scale (LEFS) and Tegner Activity Scale (TAS). Regression analysis assessed the contribution of pre-operative patient (age, sex, body mass index, TAS), injury/surgery (time from injury to surgery, injury mechanism, semimembranosus and conjoint tendon retraction) and post-operative (peak isokinetic knee flexor strength) variables, to the 2-year PHAT and reporting complete satisfaction. From baseline to 2-years, the PHAT improved by 47.1 points (95% CI, 41.9 to 52.3; p < 0.001), with 97.1% of patients meeting the PHAT minimal important change of 8.6 points by 2 years post-surgery. Furthermore, the LEFS improved by 44.5 points (95% CI, 39.9 to 49.1; p < 0.001) and TAS by 2.6 points (95% CI, 2.1 to 3.2; p < 0.001). Forty-six (78.0%) patients were ‘very satisfied’ with their 2-year outcome. Univariable analysis indicated that age (p = 0.004), baseline TAS (p = 0.006), a sport/recreation injury mechanism (p < 0.001) and 6-month normalized knee flexor torque (p = 0.030) were associated with the 2-year PHAT. In the final multivariable model, only the baseline TAS (p = 0.021) and a sport/recreation injury mechanism (p = 0.001) remained. No variable was significantly associated with being ‘very satisfied’ with 2-year surgical outcome. Clinical scores improved significantly from baseline to 2 years after proximal hamstring repair. While pre-operative TAS and a sport/recreation injury mechanism were associated with the 2-year PHAT, no variables were associated with being ‘very satisfied’ with the 2-year outcome. Prospective cohort study, Level of evidence 3.