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Sportverletz Sportschaden 2017; 31(03): 160-166
DOI: 10.1055/s-0043-113211
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

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?
Raymond Best
,
Julia Eberle
,
Florian Beck
,
Jochen Huth
,
Ulrich Becker
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Publikationsverlauf

Publikationsdatum:
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.

Schlüsselwörter

proximaler Hamstringabriss - operative Refixation - Outcome-Score - OP-Zeitpunkt

Key words

proximal hamstring tendon avulsion - surgical refixation - outcome score - time of surgery
 

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