A Comparison of Nonoperative and Operative Treatment of Complete Proximal Hamstring Ruptures

Background The early repair of acute proximal hamstring ruptures provides better clinical results than delayed repair. However, it is unclear how nonoperative treatment compares with the operative treatment of these injuries. Purpose To compare the clinical results of the nonoperative and operative treatment of acute proximal hamstring ruptures. Study Design Cohort study; Level of evidence, 3. Methods A total of 25 patients with complete, retracted proximal hamstring ruptures presenting to 1 institution were retrospectively reviewed. All patients were given the option of proximal hamstring repair at the time of the initial evaluation. Patients with at least 12 months of follow-up from the time of surgery or injury were included in the evaluation. Both nonoperative and operative treatment groups were evaluated using the same outcome measures. The primary outcome measure was the Lower Extremity Functional Scale (LEFS). Secondary outcome measures included the Short Form-12 (SF-12) physical and mental component summaries, strength testing, a single-leg hop test, the patient's perception of strength, and the ability to return to activity. Results There were 11 patients treated nonoperatively, with a mean follow-up of 2.48 ± 3.66 years, and 14 patients treated operatively, with a mean follow-up of 3.56 ± 2.11 years. The mean LEFS scores for the nonoperative and operative groups were 68.50 ± 7.92 and 74.71 ± 5.38, respectively (P = .07). No statistical differences were found between the groups regarding SF-12 scores and mean single-leg hop distance compared with the uninjured leg. Isometric testing of the injured hamstring in the nonoperative group demonstrated significant clinical weakness compared with the uninjured side at both 45° and 90° of flexion (57.54% ± 7.8% and 67.73% ± 18.8%, respectively). Isokinetic testing of the injured leg in the operative group demonstrated 90.87% ± 16.3% strength of the uninjured leg. All patients in the operative group were able to return to preinjury activities, whereas 3 patients in the nonoperative group were unable to return (chi-square = 4.33, P = .07). Conclusion Patients with acute proximal hamstring ruptures treated surgically regained approximately 90% strength of the uninjured extremity and tended to have a greater likelihood of returning to preinjury activities than patients treated nonoperatively.