Proximal hamstring tendon avulsion from the ischial tuberosity is a significant injury, with surgical repair shown to have superior functional outcomes compared to non-surgical treatment. However, limited data exists regarding the optimal rehabilitation regime following surgical repair. The aim of this study was to investigate patient outcomes following repair of proximal hamstring tendon avulsions between a conservative (CR) versus an accelerated rehabilitation (AR) regimen.

This prospective randomized controlled trial (RCT) randomised 50 patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR=25) or an accelerated, unbraced regime, that permitted full weight-bearing as tolerated (AR=25).

Patients were evaluated pre-operatively and at 3 and 6 months post-surgery, via patient-reported outcome measures (PROMs) including the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT) and 12-item Short Form Health Survey (SF-12). Primary analysis was per protocol and based on linear mixed models.

Both groups were matched at baseline with respect to patient characteristics. All PROMs improved (p>0.05) and, while the AR group reported a significantly better Physical Component Score for the SF-12 at 3 months (p=0.022), there were no other group differences. Peak isometric hamstrings strength and peak isokinetic quadriceps and hamstrings torque symmetry were all comparable between groups (p>0.05). Three re-injuries have been observed (CR=2, AR=1).

After proximal hamstring repair surgery, post-operative outcomes following an accelerated rehabilitation regimen demonstrate comparable outcomes to a traditionally conservative rehabilitation pathway, albeit demonstrating better early physical health-related quality of life scores, without an increased incidence of early re-injury.

Abstract

Customised individually made implants(CIM) total knee arthroplasty(TKA) are custom-made to better fit patients native anatomy and aim to improve outcomes which can be variable with conventional off-the-shelf(OTS).

A systematic review and meta-analysis was conducted searching the MEDLINE and Embase databases. Studies reporting on patient reported outcome measures, clinical or radiological outcomes were included.

23 studies satisfied the search criteria (case-control studies14, case series8, cross-sectional studies1). There were 2,856(CIM) and 1,877(OTS) implants. The overall revision-rate was higher in CIM 5.9%vs3.7%OTS [OR 1.46(95% CI 0.82–2.62)]. MUA was higher in the CIM group 2.2%vs.1.1%OTS [OR 2.95(95% CI 0.95–9.13)] and overall complications rate was also higher in the CIM group 5% vs. 4.5%OTS [OR 1.45(95% CI 0.53–3.96)]. LOS was significantly shorter in the CIM group 2.9 days vs. 3.5 days [MD −0.51(95% CI −0.82–0.20)]. Pooled analysis for KSS showed no difference between CIM and OTS groups(Knee=90.5 vs. 90.6 [MD-0.27,(95% CI −4.27–3.73)] and Function=86.1 vs. 90.6[MD 1.51 (95% CI −3.69–6.70)] component of the scores. There was no significant difference in post-operative ROM between CIM and OTS groups 117.3° vs. 115.0° [MD 0.02,(95% CI −1.70–1.74)].

CIM TKAs has theoretical benefits over OTS TKAs however in this review they were associated with higher complication, MUA and revision rates with no difference in outcome scores and no improvement in target alignment. The findings of this review does not support the use of CIM over OTS prosthesis in total knee arthroplasty.