Perspective

Study: Surgery better than conservative care for hamstring injuries

Patients treated surgically for acute proximal hamstring ruptures had better lower extremity function outcomes and higher chances of returning to pre-injury activities compared with nonsurgically treated patients, according to the findings from a recently presented study.

In their case-control study, Suzanne Laura Miller, MD, and her colleagues retrospectively evaluated the outcomes of 25 patients with proximal hamstring ruptures treated between 2007 and 2013. Fourteen patients were treated surgically and 11 patients underwent conservative care. The Lower Extremity Functional Score (LEFS) was used to measure primary outcomes. In addition, the researchers assessed patients using the SF-12 physical and mental component scores, the single-leg hop test, patients’ strength perception and their ability to return to activity.

Single-leg hop scores

“Our results showed no significant difference for the SF-12 physical and mental scores or perceived strength, and there was a trend toward a better LEFS in the operative group,” Miller said during her presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting. “Compared with the contralateral extremity, there was no significant difference in single-leg hop compared to the uninjured leg; however, when comparing between the two groups, there was a significant difference in the single-leg hop.”

The average single-leg hop score for the operative group was 119.1 cm compared with 56.1 cm for the nonoperative group. Compared with the uninjured leg, the average single-leg hop score in the injured leg was 5.1 cm shorter in operative group and 1.2 cm shorter in nonoperative group, according to the researchers. Age and average single-leg hop had weak associations with LEFS in both groups.

Return to pre-injury levels

The researchers also found the operative and nonoperative groups had similar strength perception. All patients in the operative group returned to pre-injury activities, whereas three patients in the nonoperative group were not able to return to activities.

“One hundred percent of patients in the surgical group were able to return to pre-injury activity level, [and] 72% of patients in the nonoperative group were able to return to pre-injury activity level,” Miller said. – by Monica Jaramillo

Disclosure: Miller reports she is a paid consultant for Stryker and has stock in Parcus.

Patients treated surgically for acute proximal hamstring ruptures had better lower extremity function outcomes and higher chances of returning to pre-injury activities compared with nonsurgically treated patients, according to the findings from a recently presented study.

In their case-control study, Suzanne Laura Miller, MD, and her colleagues retrospectively evaluated the outcomes of 25 patients with proximal hamstring ruptures treated between 2007 and 2013. Fourteen patients were treated surgically and 11 patients underwent conservative care. The Lower Extremity Functional Score (LEFS) was used to measure primary outcomes. In addition, the researchers assessed patients using the SF-12 physical and mental component scores, the single-leg hop test, patients’ strength perception and their ability to return to activity.

Single-leg hop scores

“Our results showed no significant difference for the SF-12 physical and mental scores or perceived strength, and there was a trend toward a better LEFS in the operative group,” Miller said during her presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting. “Compared with the contralateral extremity, there was no significant difference in single-leg hop compared to the uninjured leg; however, when comparing between the two groups, there was a significant difference in the single-leg hop.”

The average single-leg hop score for the operative group was 119.1 cm compared with 56.1 cm for the nonoperative group. Compared with the uninjured leg, the average single-leg hop score in the injured leg was 5.1 cm shorter in operative group and 1.2 cm shorter in nonoperative group, according to the researchers. Age and average single-leg hop had weak associations with LEFS in both groups.

Return to pre-injury levels

The researchers also found the operative and nonoperative groups had similar strength perception. All patients in the operative group returned to pre-injury activities, whereas three patients in the nonoperative group were not able to return to activities.

“One hundred percent of patients in the surgical group were able to return to pre-injury activity level, [and] 72% of patients in the nonoperative group were able to return to pre-injury activity level,” Miller said. – by Monica Jaramillo

Disclosure: Miller reports she is a paid consultant for Stryker and has stock in Parcus.

    Perspective
    Asheesh Bedi

    Asheesh Bedi

    Dr. Miller and her colleagues have presented an interesting study with long-term clinical outcomes after nonoperative or surgical treatment of acute proximal hamstring injuries in active patients. The results suggest operative repair may be favorable with regard to objective strength and lower extremity function, despite similar subjective satisfaction and perception of strength with nonoperative treatment. The results need to be interpreted with some caution, however, as the treatment was not randomized and the groups may be biased; the nonoperative group is significantly older and may have had considerably lower baseline function and expectations. This can confound the final comparison between nonoperative and operative groups at long-term follow-up.

    • Asheesh Bedi, MD
    • Harold and Helen W. Gehring Professor, University of Michigan Ann Arbor, Mich.

    Disclosures: Bedi reports no relevant financial disclosures.