German Congress of Orthopaedics and Traumatology (DKOU 2025)
Superior functional outcomes and return to sport following surgical vs. non-surgical treatment of proximal hamstring tears
Text
Purpose: To compare functional outcomes, return-to-sport (RTS) rates, and muscle strength in patients with proximal hamstring tears (PHT) treated with surgical refixation versus non-operative management. It was hypothesized that surgical treatment would result in superior functional outcomes, higher RTS rates, and greater muscle strength compared to non-surgical treatment.
Methods: Patients with PHT who were treated non-operatively between January 2008 and December 2023 were propensity score-matched (3:1) to a cohort of patients who underwent surgical refixation. Matching parameters included sex, body mass index, follow-up time, number of tendons ruptured, and age. Functional outcomes were assessed using the Perth Hamstring Assessment Tool (PHAT), Lower Extremity Functional Scale (LEFS), Modified Harris Hip Score (mHHS), and Tegner Activity Scale (TAS). Muscle strength was evaluated instrumentally using the Isobex digital strength analyzer. Additionally, RTS rates were recorded, assessing whether patients returned to their pre-injury sport level.
Results: In these preliminary data, a total of 60 patients (57% male, mean follow-up 38 ± 26 months) were analyzed after propensity score matching, with 45 patients in the surgical group matched to 15 patients in the non-surgical group (3:1 matching). Functional outcomes were significantly better in the surgical group, as demonstrated by higher PHAT scores (50.0 ± 17.0 vs. 43.3 ± 19.0, p ≤ 0.05) and LEFS scores (67.0 ± 21.0 vs. 62.0 ± 24.3, p ≤ 0.05) compared to the non-surgical group. In contrast, mHHS scores showed no significant differences between groups (76.7 ± 21.0 vs. 75.4 ± 25.7, p = 0.99).
The strength ratio (injured vs. uninjured limb) was significantly higher in the surgical group (0.88 ± 0.18) compared to the non-surgical group (0.77 ± 0.21, p ≤ 0.05). However, the isometric strength deficit (Δ strength) did not differ significantly between groups (−0.58 ± 1.22 Nm vs. −1.72 ± 1.54 Nm, p = 0.269). Significantly more patients in the surgical group returned to their pre-injury sport level or higher compared to the non-surgical group (69.6% vs. 51.5%, p ≤ 0.05).
Conclusion: These preliminary findings suggest that surgical treatment of PHT leads to superior functional outcomes, with significantly higher PHAT and LEFS scores, as well as a greater strength ratio compared to non-surgical management. However, overall isometric strength deficits did not differ. Additionally, surgically treated patients demonstrated a higher RTS rate.
