Modified surgical anchor refixation in older patients with acute proximal hamstring rupture: clinical outcome, patient satisfaction and muscle strength

Tomáš Chocholáč; Linda Bühl; Corina Nüesch; Niklas Bleichner; Annegret Mündermann; Karl Stoffel

doi:10.1007/s00402-022-04752-3

Modified surgical anchor refixation in older patients with acute proximal hamstring rupture: clinical outcome, patient satisfaction and muscle strength

Arch Orthop Trauma Surg. 2023 Aug;143(8):4679-4688. doi: 10.1007/s00402-022-04752-3. Epub 2023 Jan 9.

Authors

Tomáš Chocholáč^#¹, Linda Bühl^#^{1

2}, Corina Nüesch^{1

2

3

4}, Niklas Bleichner¹, Annegret Mündermann^{1

2

3}, Karl Stoffel⁵

Affiliations

¹ Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
² Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
³ Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.
⁴ Department of Clinical Research, University of Basel, Basel, Switzerland.
⁵ Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. karl.stoffel@usb.ch.

^# Contributed equally.

Abstract

Introduction: After conventional surgical refixation of the hamstrings after proximal hamstring rupture, patients frequently experience pain while sitting and deficits in hamstring muscle strength of the operated side. To improve these outcomes, we have modified the surgical anchor placement and have carried out a thorough follow-up examination.

Materials and methods: Thirteen older patients (8 female, 5 males) with a median age of 64.2 (range, 52.1-80.4) years were surgically treated for acute proximal hamstring rupture using modified anchor placement and participated in a follow-up assessment at a median of 46.2 (11.2-75.0) months after surgery. Patients completed the Perth Hamstring Assessment Tool (PHAT), quality of life questionnaire (EQ-5D-5L) and the Lower Extremity Functional Scale (LEFS), and rated their satisfaction level on a scale from 0 to 100%. Local tenderness on the ischial tuberosity and maximum passive hip flexion were measured on both limbs. Maximum isokinetic knee flexor muscle strength was measured bilaterally using a dynamometer.

Results: The median (range) PHAT, EQ-5D-5L and LEFS score were 78.8/100 (54.6-99.8), 0.94/1 (0.83-1) and 88.75/100 (61.25-100). The median satisfaction was 100% (90-100%). Only one patient felt discomfort when the ischial tuberosity was palpated. Neither maximum passive hip flexion nor maximum isokinetic flexor muscle strength differed between the operated and non-operated side (P > 0.58). Clinical scores did not correlate with the leg symmetry index of knee flexor muscle strength (Spearman's rho < 0.448, P > 0.125). There were no tendon re-ruptures, or postoperative sciatic radiculopathy, at the time of follow-up.

Conclusions: The modified extra-anatomical anchor placement resulted in good clinical and functional outcome of surgical repair of acute proximal hamstring rupture. Especially the absence of postoperative pain while sitting and the comparable muscle strength to the contralateral side is promising.

Clinical trial registration: ClinicalTrials.gov Identifier: NCT04867746, registered.

Keywords: Modified anchor placement; Patient satisfaction; Proximal hamstring rupture; Surgical repair.

Publication types

Clinical Trial

MeSH terms

Aged
Child
Child, Preschool
Female
Hamstring Muscles* / surgery
Hamstring Tendons* / surgery
Humans
Male
Muscle Strength
Patient Satisfaction
Quality of Life
Recovery of Function
Rupture / surgery
Tendon Injuries* / surgery

Associated data

ClinicalTrials.gov/NCT04867746

Grants and funding

Research Fellowship/Biomet Deutschland