EP7.3 Single-Stage Repair of Simultaneously Avulsed Bilateral Proximal Hamstrings: Four-Year Outcome Case Report

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ID: 331007
2026
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Abstract
Abstract Introduction Simultaneous bilateral proximal hamstring avulsions (PHAs) are rare injuries with limited mid- to long-term outcome data following single-stage repair. Staged repair avoids the logistical challenges of bilateral postoperative restrictions but requires two operations, increased anesthesia exposure, and prolonged rehabilitation. This case examines the feasibility, perioperative decision-making, and four-year patient-reported outcomes (PROs) following single-stage, bilateral proximal hamstring repair performed in the subacute setting. Case Presentation A 58-year-old male presented 20 days after sustaining simultaneous bilateral proximal hamstring avulsions while sprinting during recreational softball. MRI confirmed bilateral two-tendon conjoint tendon avulsions with retraction measuring 5.8 cm on the left and 4.5 cm on the right. The patient had no significant cardiopulmonary, hematologic, or systemic comorbidities. Management Single-stage bilateral repair was performed 22 days from injury via bilateral transverse gluteal crease incisions with sciatic neurolysis by a peripheral nerve surgeon. Bilateral hinged knee braces were locked at 30 degrees of knee flexion postoperatively. Given the bilateral nature of the repair, six weeks of wheelchair immobilization replaced standard restricted weightbearing to protect both repairs simultaneously and prevent inadvertent combined hip flexion and knee extension. Formal physical therapy began at six weeks, at which point pain was well-controlled and incisions were healing without complication. Progressive range-of-motion exercises and gradual weightbearing were introduced, with activities advanced using a criteria-based approach. By three months, hip flexion reached 100°, with a negative bowstring sign bilaterally. At six months, the patient was jogging pain-free with hip flexion of 120°, full hip extension and abduction, and 5/5 hamstring strength. Results PROs were collected preoperatively and at six months, one year, and four years. Improvements were observed across all validated outcome measures. mHHS improved from 63.8 to 100.0, iHOT-33 from 23.6 to 90.2, SANE scores improved from 26 to 85 on the left and 39 to 95 on the right, and VAS pain decreased from 47 to 0 at four years. PROMIS mobility and physical function T-scores improved from 33.0 and 36.2 preoperatively to 50.0 and 47.9 at four years, respectively. The patient reported his hip as "much improved" at all postoperative timepoints and achieved a patient acceptable symptom state. He returned to full sport at one year, including running and skiing, with no complications, recurrence, or sciatic nerve symptoms at four-year follow-up. Conclusion Single-stage bilateral proximal hamstring repair in the subacute setting is feasible in carefully selected patients and yields durable mid-term outcomes across multiple validated PROs. Wheelchair immobilization and peripheral nerve surgeon involvement are practical risk-mitigation strategies unique to bilateral repair. This approach avoids staged operative morbidity and cost while achieving functional recovery comparable to unilateral repair in this uncommon but clinically challenging scenario.
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Authors Alex Capitano, Bryan Soth, Reena Olsen, Nia J Baker, Danyal H. Nawabi
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.367
URL
https://doi.org/10.1093/jhps/hnag043.367
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