PMID- 38482843
OWN - NLM
STAT- MEDLINE
DCOM- 20240403
LR  - 20240404
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Print)
IS  - 0363-5465 (Linking)
VI  - 52
IP  - 5
DP  - 2024 Apr
TI  - Risk Factors for Rerupture After Proximal Hamstring Avulsion Injury Including the 
      Optimal Timing for Surgery.
PG  - 1173-1182
LID - 10.1177/03635465241233734 [doi]
AB  - BACKGROUND: Despite the prevalence of proximal hamstring avulsion injuries 
      (PHAIs), the understanding of rerupture risk factors and the influence of injury 
      chronicity on these rates remain limited. PURPOSE: To investigate the rerupture 
      rate after PHAI repair and identify its associated risk factors and the optimal 
      time to primary surgery. STUDY DESIGN: Case-control study; Level of evidence, 3. 
      METHOD: This is a retrospective analysis of prospectively collected data from the 
      French Proximal Hamstring Avulsion Surgery Cohort Study targeting patients 
      surgically treated for PHAI between 2002 and 2022. The primary outcome measure of 
      this study was the rerupture rate of PHAI repair. The secondary outcome measures 
      included the assessment of the potential risk factors for rerupture as well as 
      the investigation of the incidence rate of rerupture for 100 person-years 
      depending on various injury-surgery delay definitions. RESULTS: This study 
      analyzed 740 patients with a mean age of 45.9 years (SD, 13.6 years) and followed 
      up for a mean of 4.9 years (SD, 3.9 years). The rerupture rate was 4.59% 
      (34/740). Most reruptures (75%) occurred within the first 6 months after surgery 
      (median, 88.5 days; interquartile range, 39.5-182 days), and 74% were atraumatic. 
      Univariate analysis identified potential risk factors: longer initial surgery 
      delay (hazard ratio [HR], 1.03; 95% CI, 1.01-1.04; P = .04) and initial complete 
      ruptures (HR, 4.47; 95% CI, 1.07-18.7; P = .04). Receiver operating 
      characteristic curve analysis found the optimal injury-surgery delay cutoff 
      predicting rerupture to be 32 days (area under the curve, 0.62; 95% CI, 
      0.53-0.71). The relative Youden index was calculated at 0.24, corresponding to a 
      sensitivity of 65% and a specificity of 59%. Surpassing this cutoff showed the 
      highest HR (2.56), narrowest 95% CI (1.27-5.17), and highest incidence of 
      rerupture (1.42 per 100 person-years) (P = .01). In the multivariate analysis, an 
      injury-surgery delay of >32 days (HR, 2.5; 95% CI, 1.24-5.06; P = .01) and 
      initial complete ruptures (HR, 4.33; 95% CI, 1.04-18.08; P = .04) emerged as 
      significant risk factors for rerupture. CONCLUSION: This study found a 4.59% 
      rerupture risk after PHAI repair. Most reruptures (75%) occurred within the first 
      6 months after surgery. Risk factors for rerupture included chronicity and 
      initial complete injury. The optimal threshold for chronicity of PHAI lesions, 
      based on rerupture rate, was marked by an injury-surgery delay of >32 days.
FAU - Lefevre, Nicolas
AU  - Lefevre N
AD  - Clinique du sport, Paris, France.
FAU - Freiha, Kinan
AU  - Freiha K
AUID- ORCID: 0009-0002-4594-3187
AD  - Clinique du sport, Paris, France.
FAU - Moussa, Mohamad K
AU  - Moussa MK
AD  - Clinique du sport, Paris, France.
FAU - Valentin, Eugenie
AU  - Valentin E
AD  - Clinique du sport, Paris, France.
FAU - Bohu, Yoann
AU  - Bohu Y
AD  - Clinique du sport, Paris, France.
FAU - Meyer, Alain
AU  - Meyer A
AD  - Clinique du sport, Paris, France.
FAU - Hardy, Alexandre
AU  - Hardy A
AD  - Clinique du sport, Paris, France.
LA  - eng
PT  - Journal Article
DEP - 20240314
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Humans
MH  - Middle Aged
MH  - Cohort Studies
MH  - Retrospective Studies
MH  - Case-Control Studies
MH  - *Hamstring Muscles/surgery/injuries
MH  - *Leg Injuries
MH  - Risk Factors
MH  - *Soft Tissue Injuries
MH  - Rupture/surgery
PMC - PMC10986149
OTO - NOTNLM
OT  - chronicity
OT  - proximal hamstring avulsion injuries
OT  - rerupture
OT  - risk factors
OT  - surgical repair
COIS- One or more of the authors has declared the following potential conflict of 
      interest or source of funding: N.L. is a consultant for WebSurvey Society, Paris, 
      France. A.H. is a consultant for Arthrex and DePuy. AOSSM checks author 
      disclosures against the Open Payments Database (OPD). AOSSM has not conducted an 
      independent investigation on the OPD and disclaims any liability or 
      responsibility relating thereto.
EDAT- 2024/03/14 12:49
MHDA- 2024/04/03 06:44
PMCR- 2024/04/02
CRDT- 2024/03/14 08:02
PHST- 2024/04/03 06:44 [medline]
PHST- 2024/03/14 12:49 [pubmed]
PHST- 2024/03/14 08:02 [entrez]
PHST- 2024/04/02 00:00 [pmc-release]
AID - 10.1177_03635465241233734 [pii]
AID - 10.1177/03635465241233734 [doi]
PST - ppublish
SO  - Am J Sports Med. 2024 Apr;52(5):1173-1182. doi: 10.1177/03635465241233734. Epub 
      2024 Mar 14.