Inferior Clinical Outcomes Following Endoscopic Proximal Hamstring Repair in Patients With Chronic Degenerative Tears Despite the Use of Dermal Allograft Augmentation.

Purpose: To compare clinical outcomes in patients undergoing endoscopic proximal hamstring repair with and without dermal allograft augmentation.

Methods: A retrospective review of prospectively collected data was performed on patients undergoing endoscopic proximal hamstring repair (PHR) and proximal hamstring repair with dermal allograft augmentation (PHR-A) by a single surgeon between 2016 and 2023. Augmentation was utilized for cases of chronic degenerative tears (≥6 weeks from the time of initial injury) where hamstring tissue quality was deemed poor intraoperatively. A survey of patient-reported outcome measures (PROMs) was completed at a minimum of 1 year postoperatively. PROMs included a visual analog scale (VAS) for pain; University of California, Los Angeles (UCLA) Activity Scale; modified Harris Hip Score (mHHS); Hip Outcome Score-Sports-Specific Subscale (HOS-SSS); and a Single Assessment Numeric Evaluation (SANE). The proportion of patients achieving the minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB) for PROMs were compared between groups.

Results: Sixty-four patients were included (42 PHR, 22 PHR-A). No differences were seen between the PHR and PHR-A groups in terms of age at surgery (49 ± 12 vs 54 ± 9; P = .08), sex, or body mass index (BMI). There was a significantly longer time to follow-up (41.5 ± 23.4 vs 20.1 ± 10.2 months; P < .001) in the PHR group. There were significantly greater postoperative mHHS (82.7±15.1 vs 72.0 ± 18.0; P = .02) and SANE (89.6 ± 9.9 vs 73.6 ± 22.5; P = .002) scores in the PHR group. There were no significant differences in postoperative VAS, UCLA, or HOS-SSS between groups. A greater proportion of patients in the PHR group achieved a SCB for mHHS (71% vs 36%; P = .008).

Conclusions: Our study demonstrates inferior clinical outcomes in patients undergoing endoscopic proximal hamstring repair with dermal allograft augmentation compared to patients undergoing endoscopic proximal hamstring repair without augmentation.

Level Of Evidence: Level III, retrospective comparative case series.