None listed
Conditions
Brief summary
This is a prospective randomised controlled trial (RCT) comparing the outcomes for patients undergoing proximal hamstring tendon avulsion repair with two different post-operative rehabilitation regimes. The first regime includes a period of brace immobilisation and limited weight-bearing with a gradual progression of physiotherapy. The second regime allows immediate full-weight bearing with an accelerated rehabilitation program of physiotherapy. Patient outcomes will be collected and compared between the two rehabilitation regime cohorts over a 24-month post-operative period. This will include validated Patient Reported Outcome Measures (PROMs) investigating pain, symptoms and patient satisfaction, and objective measures of hip range of motion (ROM), muscle girth, peak isokinetic knee flexor (hamstrings) and extensor (quadriceps) strength. Overall satisfaction and assessment of complications will be assessed throughout.
Interventions
Group One: Conventional rehabilitation. Hinged knee brace applied post-operatively locked at 30 degrees of flexion. Toe-touch weight bearing for 2 weeks followed by 4 weeks of partial (50%) weight bearing. Full weight bearing can begin from the start of week 7. Short stride length prescribed. Isometric lower limb exercises (excluding hamstring) immediately. These exercises were advised for 15 minutes twice daily. Isometric hamstring exercises from 6 weeks. These were advised for 15 minutes twice
Group One: Conventional rehabilitation. Hinged knee brace applied post-operatively locked at 30 degrees of flexion. Toe-touch weight bearing for 2 weeks followed by 4 weeks of partial (50%) weight bearing. Full weight bearing can begin from the start of week 7. Short stride length prescribed. Isometric lower limb exercises (excluding hamstring) immediately. These exercises were advised for 15 minutes twice daily. Isometric hamstring exercises from 6 weeks. These were advised for 15 minutes twice daily. Rehabilitation to progress from here guided by the patients own physiotherapist. Personal and face to face physiotherapy advised and guided by patients progress. Compliance and current function was monitored via phone calls by the research team. Patients were contact at 1-2 weeks to check early complicance. Then they were contacted via phone/email at 6 weeks and 12 weeks. This rehabilitation would continue to 3 months then both groups could progress as able with no restriction.
Sponsors
Coastal orthopaedics
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
- Age 18-65 years. - Presenting to the surgeon and operated on within 42 days of their injury. - Physical examination supporting the diagnosis; positive hip extension test, palpable defect and/or local tenderness and haematoma. - MRI showing complete acute avulsion of at least two of three tendons from the footprint at the ischial tuberosity. - Patients able to give written informed consent.
Exclusion criteria
• The individual is unable or unwilling to sign the Patient Informed Consent, specific to this study, and approved by the Institutional Ethics Review Board. - The individual is unable or unwilling to follow the designated rehabilitation protocol. - The individual is classified as morbidly obese (>40 BMI). - The individual is skeletally immature. - Revision procedures. - Isolated semimembranosus ruptures. - Ruptures > 4cm away from the ischial tuberosity - The individual is currently being treated for a psychiatric disorder, senile dementia, Alzheimer’s disease, presence of alcohol/substance abuse
Outcome results
None listed