Partial Tenotomy and Reattachment for Chronic Proximal Hamstring Tendinopathy: Functional Outcomes, Return to Sport, and Patient Satisfaction

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Background: Chronic proximal hamstring tendinopathy (PHT) can cause significant pain and functional impairment, particularly in active individuals. While nonoperative management is the first-line treatment, some patients with persistent symptoms may require surgical intervention. Purpose: To evaluate the functional outcomes, return-to-sport rates, and complication profiles of patients undergoing partial tenotomy and reinsertion for chronic PHT. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study targeted patients who underwent partial tenotomy and reattachment of the proximal hamstring tendons between April 2010 and September 2022. The indication for surgery was refractory chronic PHT symptoms for >6 months. The primary outcome measure was the Parisian Hamstring Avulsion Score (PHAS). Secondary outcomes included the Tegner Activity Scale score, University of California–Los Angeles (UCLA) Activity Scale score, return to sport, postoperative patient satisfaction, and the rate of complications. In this study, the terms “partial involvement” or “complete involvement” refer to the extent of magnetic resonance imaging signal changes across the tendon, rather than to true tendon ruptures or avulsions. Results: The study included 42 patients with a mean age of 50.4 years (SD, 10.4 years). The mean follow-up was 4.1 years (range, 2.0-12.6 years). The PHAS score significantly improved from a preoperative mean of 63.0 (SD, 11.4) to 84.2 (SD, 18.2) at the final follow-up ( P < .001). The median Tegner Activity Scale score increased from 3.0 (IQR, 2.0-4.0) to 4.0 (IQR, 3.0-5.0) ( P < .001), and the median UCLA score improved from 4.0 (IQR, 4.0-6.0) to 8.0 (IQR, 5.0-10.0) ( P < .001). At the last follow-up, 30 of 39 patients (76.9%) returned to sport, with 18 of 39 (46.2%) achieving their preinjury sport level or higher. The median time to return to sport was 5.2 months (IQR, 3.7-6.3 months). Patient satisfaction was high, with 82.1% reporting satisfaction with the operated leg. The reattachment failure rate was 4.8%. Conclusion: Partial tenotomy and reattachment for chronic PHT result in significant functional recovery, a high return-to-sport rate, and good patient satisfaction.

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