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DOI: 10.1055/s-0043-113211
Operative Refixation bei proximalem Hamstringabriss: Ist der OP-Zeitpunkt relevant für das funktionelle Outcome?
Surgical Refixation after Proximal Hamstring Tendon Avulsion Injuries: Does the Time of Surgery Influence Functional Outcomes?Publication History
Publication Date:
04 September 2017 (online)
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Zusammenfassung
Hintergrund Komplette Rupturen der proximalen Hamstringsehnen sind selten, im Falle einer solchen stellt die operative Refixation die therapeutische Methode der Wahl dar. Bislang ist das postoperative Outcome sehr heterogen und wenig vergleichbar untersucht, sodass Aussagen bezüglich einer Korrelation des Outcomes zu OP-Methoden und Zeitpunkt der OP nach Trauma nur begrenzt möglich sind.
Ziel Es soll anhand des neuen, validierten und verletzungsspezifischen Perth Hamstring Assessment Tools (PHAT) das postoperative Outcome eines eigenen Kollektivs untersucht und dies in Korrelation zum Abstand zwischen Trauma und Operation dargestellt werden.
Methode In dieser retrospektiven Fallkontrollstudie wurden alle operierten Patienten zwischen 1/2011 und 3/2016 und einer zurückliegenden OP-Zeitpunkt von mindestens 6 Monaten gebeten, ihr subjektives funktionelles Outcome anhand des PHAT – Fragebogens zu dokumentieren. Je nach Zeitraum zwischen Trauma und OP wurden die Patienten und deren Fragebogenergebnisse dabei einer akut (<vier Wochen), einer verzögert (1-3 Monate) oder einer verspätet (>3 Monate) versorgten Gruppe zugeordnet.
Ergebnisse Von 64 operierten Patienten im genannten Zeitraum konnten 57 in die Studie eingeschlossen werden, von denen wiederum 39 (68 %) den PHAT-Score vollständig komplettierten. Der mittlere PHAT-Score (0 – 100 Pkt.) aller Patienten betrug 72,4 Punkte (SD ± 21,0). Es ergab sich kein signifikanter Unterschied zwischen der akut und der verzögert versorgten Gruppe (77,0 Punkte ± 22,0 vs. 63,4 Punkte ± 16,2; p: 0,067), jedoch ein deutlich signifikanter Unterschied zwischen der akut und der verspätetet operierten Gruppe (77,0 Punkte ± 22,0 vs. 58,3 Punkte ± 20,2; p: 0,021).
Schlussfolgerung In der vorliegenden Studie kann gezeigt werden, dass eine schnelle Indikationsstellung einer proximalen Hamstringverletzung mit einer operativen Versorgung innerhalb von 4 Wochen zu einem signifikant besseren, funktionellen Outcome führt als verspätet versorgte Rupturen.
Abstract
Background Proximal hamstring tendon avulsion injuries are rare. If they do occur, surgical treatment with tendon refixation is regarded as the method of choice. Surgical outcome measurements have been investigated heterogeneously and, therefore, are difficult to compare. Hence, the possibility for correlations between postoperative outcomes and surgical methods or time of surgery is limited.
Objective Using the new, validated and injury-specific Perth Hamstring Assessment Tool (PHAT), we aimed to investigate a population of own patients in order to compare the results in relation to the time of surgery after trauma.
Methods In this retrospective case control study, all patients who had undergone hamstring avulsion surgery between 1/2011 and 3/2016 with a follow-up period of at least six months were asked to document their subjective functional outcome using the PHAT. Depending on the time of surgery after trauma, patients and the results of their questionnaires were assigned either to an acute (< 4 weeks), a delayed (1 – 3 months) or a chronic (> 3 months) group.
Results In the named period, 64 patients had a hamstring refixation surgery, 57 of them could be included in the study. 39 (68 %) returned the completed PHAT questionnaire. The mean PHAT score (0 – 100 pts.) was 72.4 (SD ± 21.0). There was no significant difference between the acute and the delayed group (77.0 ± 22.0 vs. 63.4 ± 16.2; p: 0.0673), whereas a significant difference was detected between the acute and the chronic group (77.0 ± 22.0 vs. 58.3 ± 20.2; p: 0.0214).
Conclusion The results of this study show that an early diagnosis and subsequent operation of a hamstring tendon avulsion injury leads to significant better functional outcomes compared with chronic procedures.
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Literatur
- 1 Cohen SB, Bradley JP. Acute proximal hamstring rupture. J Am Acad Orthop Surg 2007; 15: 350-355
- 2 Harris JD, Griesser MJ, Best TM. et al. Treatment of proximal hamstring ruptures – a systematic review. Int J Sports Med 2011; 32: 490-495
- 3 Lempainen L, Banke I, Johasson K. et al. Clinical principles in the management of hamstring injuries. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2449-2456
- 4 Van der Made AD, Reuring G, Gouttebarge V. et al. Outcome after surgical repair of proximal hamstring avulsions. Am J Sports Med 2015; 43 (11) 2841-2851
- 5 Cohen SB, Rangavajjula A, Vyas D. et al. Functional results and outcomes after repair of proximal hamstring avulsions. Am J Sports Med 2012; 40: 2092-2098
- 6 Rust DA, Giveans MR, Stone RM. et al. Functional outcomes and return to sports after acute repair, chronic repair, and allograft reconstruction for proximal hamstring ruptures. Am J Sports Med 2014; 42 (06) 1377-1383
- 7 Blakeney WG, Zilko SR, Edmonston SJ. et al. Proximal hamstring tendon avulsion surgery: evaluation of the Perth Hamstring Assessment Tool. Knee Surg Sports Traumatol Arthrosc [epub ahead of print, published 25 june 2016]
- 8 Pombo M, Bradley JP. Proximal hamstring avulsion injuries: a technique note on surgical repairs. Orthopaedics 2009; 1 (03) 261-264
- 9 Subbu R, Benjamin-Laing H, Haddad F. Timing of surgery for complete proximal hamstring avulsion injuries: successful clinical outcomes at 6 weeks, 6 months, and after 6 months of injury. Am J Sports Med 2015; 43 (02) 385-391
- 10 Brucker PU, Imhoff AB. Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 2005; 13: 411-418
- 11 Bowman KF, Cohen SB, Bradley JP. Operative management of partial-thickness tears of the proximal hamstring muscles in athletes. Am J Sport Med 2013; 41 (06) 1363-1371
- 12 Birmingham P, Muller M, Wickiewicz T. et al. Functional outcome after repair of proximal hamstring avulsions. J Boine Joint Surg (Am) 2011; 93 (19) 1819-1826
- 13 Cahal J, Bush-Joseph CA, Chow A. et al. Clinical and magnetic resonance imaging outcomes after surgical repair of complet proximal hamstring ruptures: does the tendon heal?. Am J Sports Med 2012; 40 (10) 2325-2330
- 14 Konan S, Haddad F. Successful return to high level sports following early surgical repair of complete tears of the proximal hamstring tendons. Int Orthop 2010; 34 (01) 119-123
- 15 Sandmann GH, Hahn D, Amereller M. et al. Mid-term functional outcome and return to sports after proximal hamstring tendon repair. Int J Sports Med 2016; 37: 570-576
- 16 Gilbert F, Boehm D, Eden L. et al. Comparing the MRI based Goutallier Classification to an experimental quantitative MR spectroscopic fat measurement of the supraspinatus muscle. BMC Musculoskeletal Disorders 2016; 17 (01) 355-362
- 17 Folsom GJ, Larson CM. Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 2008; 36 (01) 104-109
- 18 Sarimo J, Lempainen L, Mattila K. et al. Complete proximal hamstring avulsions: a series 41 patients with operative treatment. Am J Sports Med 2008; 36 (06) 1110-1115
- 19 Brucker PU, Imhoff AB. Refixation of complete tendon ruptures of proximal ischio-crural muscles. Unfallchirurg 2004; 107 (02) 143-148
- 20 Bauer S, Riegger M, Reichert W. Complete proximal hamstring avulsion tear: Anchor based sliding suture technique for reduction and fixation. Unfallchirurg 2016; 119 (12) 1043-1048
- 21 Feucht MJ, Plath JE, Seppel G. et al. Gross anatomical and dimensional characteristics oft he proximal hamstring origin. Knee Surg Sports Traumatol Arthrosc 2015; 23 (09) 2576-2582
- 22 Binkley JM, Stratford PW, Lott SA. et al. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties and clinical application. Phys Ther 1999; 79: 371-383
- 23 Marx RG, Stump TJ, Jones EC. et al. Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med 2001; 29: 213-218
- 24 Hinkle DE, Wiersma W, Jurs SG. et al. Applied statistics for the behavioral sciences. Boston: Houghton Mifflin; 2003: 107-110
- 25 Skaara HE, Mosknes H, Frihagen F. et al. Self-reported and perfomance-based functional outcomes after surgical repair of proximal hamstring avulsions. Am J Sports Med 2013; 41 (11) 2577-2584
- 26 Blakeney W, Zilko S, Edmonston S. et al. A prospective evaluation of proximal hamstring tendon avulsion: improved functional outcomes following surgical repair. Knee Surg Sports Traumatol Arthrosc [epub ahead of print, published 9 march 2017]
- 27 Wood DG, Packham I, Trikha SP. et al. Avulsion of the proximal hamstring origin. J Bone Joint Surg Am 2008; 90 (11) 2365-2374