The impact of non weight bearing: A prospective cohort study.

BACKGROUND: Patients with lower limb injuries are commonly advised to non weight bear (NWB) on their injured limb as part of treatment. Occasionally, patients complain that offloading one limb, associated with the use of crutches or other mobility aids, may lead to pain on one of the other supporting limbs. This has led to compensation claims (1) but has never been the subject of formal research. METHODS: A prospective cohort trial was undertaken to address this question. Patients were recruited from two Metropolitan Hospital Orthopaedic Fracture Clinics and Orthopaedic Wards. A survey was administered at two time points; the first at the point of definitive orthopaedic treatment and commencement of the NWB phase. The second after the NWB phase was completed. The surveys included a pain Visual Analogue Scale (VAS), Short Form (SF)12, a pain body chart and a health questionnaire. RESULTS: A total of 55 patients were enrolled in the study. Seven patients developed new joint pain after a period NWB. These patients scored significantly lower on the follow up SF12 when compared to those who did not develop new pain (p=0.045). Follow up phone calls at least 6 months following completion of the second survey revealed that all initial and new pain areas in these participants had resolved. The main limitation of this study was the limited numbers. CONCLUSION: This study supports the idea that crutches, prescribed in the short term to allow a limb to be NWB, achieve this aim with minimal impact. Their use may be associated with new other joint pain however it can be anticipated this will resolve after cessation of crutch use.

The Lower Limb Functional Index - A reliable and valid functional outcome assessment in burns.

Lower limb injuries account for up to 40% of all burns in Western Australia and affect physical function. Lower limb specific functional assessments are available to monitor recovery, yet no scale has been assessed for use in burns. The Lower Limb Functional Index (LLFI) which is validated in musculoskeletal patients was investigated for applicability in burn. Reliability was assessed using Cronbach's alpha, principal components analysis and Rasch analysis. Validity was assessed using Spearman's correlation coefficient with quality of life assessments (BSHS-B & SF-36) and physical assessments (TUG & ankle ROM). Regression analysis was performed with burn severity measures, time of recovery and location of the burn. The LLFI-10 was applied 1368 times on 739 patients at regular time points. It was internally consistent (α>0.8) and unidimensional. Associations were demonstrated with the BSHS-B and SF-36 (rho=-0.56 to -0.72, p<0.001), TUG (rho=0.41, p<0.001) and ankle ROM (rho=-0.31 to -0.35, p<0.001). The LLFI-10 also showed associations (p<0.001) with time since injury (rho=-0.29), age (rho=0.12) and TBSA (rho=0.12). The LLFI-10 is a reliable and valid tool to assess function in lower limb burns. This study supports the use of the LLFI-10 as part of a battery of assessment for lower limb burn recovery.

[Interdisciplinary Assessment Criteria for Rehabilitation after Injuries of the Lower Extremity: A Function-Based Return to Activity Algorithm]. / Interdisziplinäre Beurteilungskriterien für die Rehabilitation nach Verletzungen an der unteren Extremität: Ein funktionsbasierter Return to Activity Algorithmus.

BACKGROUND: In the treatment of patients with lower extremity injuries, a paradigm shift is taking place: Time-dependent concepts are increasingly being replaced by function-based concepts. METHODS: A function-based Return to Activity Algorithm is presented which contains a level classification (I-IV). Qualitative and subsequent quantitative tests are assigned to every level. Within each level, first the respective qualitative test has to be passed before patients are allowed to perform the corresponding quantitative test. Criteria for success are qualitative and quantitative comparisons with the unaffected side. Before entering the next level, both tests have to be successfully passed. The levels are ordered according to increasing demands on the loco-motor system. These demands are adequate stability without impact interaction in sagittal plane for level I, followed by dynamic stability demands for level II. Impacts in frontal plane are added for level III and finally multidirectional impacts have to be compensated at level IV. The time expenditure per level is no more than five minutes. The case of a professional soccer player will serve to exemplify the Return to Activity Algorithm. Following a knee injury, he underwent arthroscopy with ACL reconstruction (patellar tendon) and a partial meniscectomy (lateral and medial). RESULTS: The athlete was able to successfully pass each level and finished his rehabilitation 203 days post injury. He returned to the team training 221 days post injury. 247 days post injury, the athlete completed his first game. CONCLUSION: The Return to Activity Algorithm is able to support the evaluation of the functional status of the loco-motor system after injury or surgery and is furthermore capable of uncovering deficits or asymmetries, which are a proven risk for re-injury. This function-oriented individual approach is able to adequately dose the therapeutic efforts on an individual basis. With this approach, the right timing for a safe return to sports activities can be detected with high certainty.

Examining the Association Between Comorbidity Indexes and Functional Status in Hospitalized Medicare Fee-for-Service Beneficiaries.

BACKGROUND: Medicare data from acute hospitals do not contain information on functional status. This lack of information limits the ability to conduct rehabilitation-related health services research. OBJECTIVE: The purpose of this study was to examine the associations between 5 comorbidity indexes derived from acute care claims data and functional status assessed at admission to an inpatient rehabilitation facility (IRF). Comorbidity indexes included tier comorbidity, Functional Comorbidity Index (FCI), Charlson Comorbidity Index, Elixhauser Comorbidity Index, and Hierarchical Condition Category (HCC). DESIGN: This was a retrospective cohort study. METHODS: Medicare beneficiaries with stroke, lower extremity joint replacement, and lower extremity fracture discharged to an IRF in 2011 were studied (N=105,441). Data from the beneficiary summary file, Medicare Provider Analysis and Review (MedPAR) file, and Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) file were linked. Inpatient rehabilitation facility admission functional status was used as a proxy for acute hospital discharge functional status. Separate linear regression models for each impairment group were developed to assess the relationships between the comorbidity indexes and functional status. Base models included age, sex, race/ethnicity, disability, dual eligibility, and length of stay. Subsequent models included individual comorbidity indexes. Values of variance explained (R(2)) with each comorbidity index were compared. RESULTS: Base models explained 7.7% of the variance in motor function ratings for stroke, 3.8% for joint replacement, and 7.3% for fracture. The R(2) increased marginally when comorbidity indexes were added to base models for stroke, joint replacement, and fracture: Charlson Comorbidity Index (0.4%, 0.5%, 0.3%), tier comorbidity (0.2%, 0.6%, 0.5%), FCI (0.4%, 1.2%, 1.6%), Elixhauser Comorbidity Index (1.2%, 1.9%, 3.5%), and HCC (2.2%, 2.1%, 2.8%). LIMITATION: Patients from 3 impairment categories were included in the sample. CONCLUSIONS: The 5 comorbidity indexes contributed little to predicting functional status. The indexes examined were not useful as proxies for functional status in the acute settings studied.

Health care costs and functional outcomes of road traffic injuries in the Lazio region of Italy.

The economic consequences of road traffic injuries (RTIs) are very important in terms of health care costs. The aim of this study is to provide estimates of health care costs of non-fatal RTIs and to estimate functional outcomes using in-hospital rehabilitation data. We identified all emergency department (ED) visits related to RTI during 2008 and then linked them with hospital discharges and rehabilitation admissions, health care costs following RTI were estimated from the integrated database. We performed an epidemiological evaluation of RTI with a comprehensive description of functional outcomes at 6 months. Health care costs have been estimated at about €80 million with a per person cost of €522. About 18% of the total cost was due to rehabilitation treatments. In multivariate analysis the variables that correlated better with higher total health care costs were: older age, injury severity, presence of spinal lesion. Patients requiring rehabilitation were: the elderly, patients suffering from a spinal cord injury and leg injuries. This study provides consistent health care cost estimates of RTI using administrative databases and it shows a picture of functional outcomes after RTI. Further research is needed for the estimation of other components of the total cost of RTI.

Rehabilitation assessment for lower limb disability based on multi-disciplinary approaches.

Low limb rehabilitation training is recognized as a very effective technique to facilitate body recovery. To make rehabilitation more efficient, we need to monitor the whole progress and detect how well the patient improves. The physician could make an optimal treatment plan according to the patient's improvement only when the patient's condition is correctly evaluated. Also, it is essential to provide a rehabilitation assessment system which would enable more accurate tracking of patient's status and minimize the requirement of time-consuming manual evaluations conducted by skilled person. Traditionally, clinical rehabilitation assessment is performed manually, which is not only coarse but also time-consuming. In this paper, we propose an objective, quantitative and manual-independent assessment system for lower extremity rehabilitation. Four predictive variables, i.e. rang of motion (ROM), movement smoothness, trajectory error, and improved L-Z complexity of electromyographic signal (EMG), are explored besides conventional clinical assessment scales. A cost-effective and wearable human-independent device which mainly consists of two sensors (MPU6050 and HMC5883L), is developed to measure the ROM, movement smoothness and trajectory error. What's more, a 3D leg model is employed to visualize the leg motion in real-time on PC screen to increase the entertainment. Those physical quantities are more sensitive at the early stage of rehabilitation. And when the basic body function is recovered, the subtle rehabilitation improvement can only be detected by the intrinsic EMG signal. Therefore an improved L-Z complexity of EMG is applied to combine with physical assessment metrics. Compared with traditional L-Z complexity, the improved one proposed in this paper could reflect more precisely the underlying property of EMG signal. The future work is to integrate all the evaluation metrics, thus we introduce a BP network to quantize a final assessment outcome.

The concurrent validity and responsiveness of the high-level mobility assessment tool for mobility limitations in people with multitrauma orthopedic injuries.

OBJECTIVE: To investigate the concurrent validity, responsiveness, and ceiling effect of the revised High-Level Mobility Assessment Tool (HiMAT) in persons after orthopedic multitrauma. DESIGN: Cross-sectional sample of convenience. SETTING: A large tertiary rehabilitation hospital. PARTICIPANTS: Forty-three participants with orthopedic multitrauma lower limb injuries that resulted from motor vehicle accidents. METHODS: This study compared the concurrent validity, responsiveness, and ceiling effects of the revised HiMAT, motor subsection of the Functional Independence Measure (FIM) instrument. Performances for all participants were concurrently scored on the motor FIM, revised HiMAT, and the Lower Extremity Functional Scale (LEFS) at initial testing, and 6 and 12 weeks after the decision to fully bear weight. MAIN OUTCOME MEASUREMENTS: Revised HiMAT, motor FIM, and LEFS. RESULTS: The correlation between the revised HiMAT and the motor FIM was moderate (r = 0.49; P <.001) and partly induced by a ceiling effect in the motor FIM. After 12 weeks of full weight bearing, 51.2% of participants achieved the maximum score on the motor FIM. The correlation between the revised HiMAT and LEFS was weak (r = 0.39; P = .012), which indicated a weak relationship between self-reported mobility problems and actual performance. The revised HiMAT was more responsive than the motor FIM and the LEFS, based on the proportion of persons who exceeded the minimal detectable change score over a period of 6 and 12 weeks. CONCLUSION: The revised HiMAT is more responsive to change than the LEFS and motor FIM, and less susceptible to a ceiling effect than the motor FIM for persons with orthopedic multitrauma. It has poor-to-moderate concurrent validity with the LEFS and motor FIM, which suggests that it may be measuring a different aspect of mobility.

Integrating health-related quality of life with sickness leave days for return-to-work assessment in traumatic limb injuries.

PURPOSE: A novel indicator called health-adjusted leave days (HALDs) is proposed. It integrates the opposite level of health-related quality of life (HRQoL) with the sick leave days (LDs) before return-to-work (RTW) to better measure the impact of injuries on occupational health. METHODS: A total of 1,167 limb injuries were consecutively recruited in a teaching hospital from January to December 2009. The number of LDs was calculated between the date of injury and the first episode of RTW. Each subject was repeatedly assessed with EuroQol instrument (EQ-5D) before RTW. The HRQoL index is defined as 1 minus the EQ-5D utility and re-scaled to 0-1 range to reflect the impact of injuries. The expected HALD of each group is calculated by integrating the product of the proportion of non-RTW function and the mean HRQoL index function over the days followed up to 2 years for the group. We compared the expected HALDs between subgroups according to various demographic characteristics and consequences of injury. RESULTS: Older and female workers tended to have longer LDs than men and younger workers, with an increase in percentage change of 16.0 or 139.5 %, respectively. After adjusting for HRQoL index, the percentages for HALDs were changed to 28.7 or 186.6 %, respectively. The percentages for the less-educated workers and blue collar workers were 185.7 and 155.8 %. The expected HALDs showed statistical significant differences in all subgroup analyses. CONCLUSION: We believed that the proposed HALD could better measure the impact of injuries and is potentially useful for the clinical decision and industrial policy-making with respect to the assessment of the importance of limb injury due to a worker's sick leaves.

Physical therapy services utilization and length of stay for obese patients following traumatic leg fracture.

BACKGROUND: Obesity is an increasing epidemic that can complicate the treatment of simple injuries and can increase health care costs. The purpose of the present study was to determine whether obesity is a factor in the utilization of inpatient physical therapy services and length of stay following a traumatic lower leg fracture. METHODS: A retrospective study of patients admitted to the hospital in 2005 and 2006 with a primary discharge diagnosis of lower leg or ankle fracture was conducted. Inclusion criteria were age > or = 18 years, only 1 involved lower extremity, and nonweight-bearing on the affected extremity per physician orders. Patients were excluded from the study if they had a fibular fracture only, pathological fractures, multiple trauma, severe cardiac or vascular comorbidities, or cognitive impairments. Data were compiled into 3 categories on the basis of body mass index (BMI): < 30, 30-35, > 35. Physical therapy services were measured in 15-minute units of time. These data were analyzed by within-group and between-group comparisons and with regression analysis. RESULTS: A total of 181 patients with a primary discharge diagnosis of distal lower extremity or ankle fracture were included in the study. Patients with a BMI >35 used more physical therapy services (mean services, 9.8 units) than did patients with a BMI of 30-35 (mean services, 6.2 units) or a BMI <30 (mean services, 5.6 units) (P = .001). Length of stay was also highest among patients with a BMI >35. LIMITATIONS: Factors other than BMI may be associated with length of stay and physical therapy use and may confound the association. CONCLUSION: Previous studies have shown that there is an increase in health care utilization among the bariatric population. The present study demonstrates similar findings for physical therapy services. Increased length of stay and physical therapy utilization among the bariatric population also result in increased staff utilization and equipment costs.

The need for lumbar-pelvic assessment in the resolution of chronic hamstring strain.

A lumbar-pelvic assessment and treatment model based on a review of clinical and anatomical research is presented for consideration in the treatment of chronic hamstring strain. The origin of the biceps femoris muscle attaches to the pelvis at the ischial tuberosity and to the sacrum via the sacrotuberous ligament. The biomechanics of the sacroiliac joint and hip, along with lumbar-pelvic stability, therefore play a significant role in hamstring function. Pelvic asymmetry and/or excessive anterior tilt can lead to increased tension at the biceps origin and increase functional demands on the hamstring group by inhibiting its synergists. Joint proprioceptive mechanisms may play a significant role in re-establishing balance between agonists and antagonists. An appreciation of neuromuscular connections as well as overall lumbar-pelvic structural assessment is recommended in conjunction with lumbar-pelvic strengthening exercises to help resolve chronic hamstring strain.

Orthopedic surgeons and physical therapists differ in assessment of need for physical therapy after traumatic lower-extremity injury.

BACKGROUND: Lower-extremity injuries constitute the leading cause of trauma hospitalizations among people under the age of 65 years. Rehabilitation has the potential to favorably influence the outcomes associated with traumatic lower-extremity injuries. OBJECTIVES: The objectives of this study were to explore variability in surgeon and physical therapist assessments of the need for physical therapy in patients with traumatic lower-extremity injuries and to determine the factors associated with assessments of need. DESIGN: This study was a retrospective cohort investigation. METHODS: Participants were 395 patients treated by reconstruction in the Lower-Extremity Assessment Project. They were evaluated at 8 level I trauma centers at 3, 6, and 12 months after hospitalization by an orthopedic surgeon and a physical therapist to determine the need for physical therapy. Analyses included multilevel logistic regression. RESULTS: Chi-square analyses showed that surgeon and therapist assessments of need differed statistically across trauma centers. Surgeons were more likely to assess a need for therapy at 3 months when participants had low work self-efficacy, impaired knee flexion range of motion (ROM), and weight-bearing limitations and at 6 and 12 months when participants had impaired knee flexion ROM and weight-bearing and balance limitations. Therapists were more likely to assess a need for therapy at 3 months when participants had moderate to severe pain and at 6 and 12 months when participants had low work self-efficacy, pain, impaired knee flexion ROM, and balance limitations. CONCLUSIONS: The results revealed variability in assessments of the need for physical therapy at the provider and trauma center levels. Differences in provider assessments highlight the need for communication and further investigation into the outcomes and timing of physical therapy for the treatment of traumatic lower-extremity injuries.

Worker's compensation and return-to-work following orthopaedic injury to extremities.

OBJECTIVE: To explore the influence of workers' compensation coverage on injury patterns and return-to-work outcome in orthopaedic injuries of the extremities. DESIGN: Prospective and follow-up study. SUBJECTS: A total of 154 subjects were recruited and 37.7% of the injuries were covered by workers' compensation. METHODS: Baseline data were obtained by questionnaire and chart review. The main outcome variable was time of first return to work. Subjects were followed up at 1, 3 and 6 months after initial interview. Cox proportional hazards model was used to analyse associations between potential predictors and return-to-work. RESULTS: The workers' compensation group were most likely to be men employed in labour occupations and were most likely to sustain crushing injuries, or injuries from being struck by objects. The 6-month return-to-work rates for the workers' compensation and non-workers' compensation groups were 70.7% and 71.9%. Early return-to-work was associated with more years in higher education, and increased self-efficacy in both groups. Moreover, age older than 45 years and hospitalization less than 14 days were associated with early return-to-work in the non-workers' compensation group. CONCLUSION: The injury patterns of workers' compensation and non-workers' compensation groups differed, but the likelihood of return-to-work at 6-month follow-up was similar. More years of education and self-efficacy were positive predictors of return-to-work.

The physiological cost of restricted weight bearing.

BACKGROUND: To identify the energy cost of placing restrictions on weight bearing status. METHODS: Measurement of the Physiological cost index (PCI) for 11 healthy volunteers carrying out three types of mobilisation over a 100 m course in a physiology laboratory: normal walking fully weight bearing (FWB); non-weight bearing (NWB) and feather touch weight bearing (FTWB). NWB and FTWB were performed using a walking frame for support. FTWB was defined as mobilisation with the foot flat, as in normal gait, but with less than 100 N force generated through the limb. RESULTS: Both NWB and FTWB developed significantly greater PCI than normal walking. There was no physiological cost benefit of FTWB over NWB, p=0.67, but FTWB was perceived by all participants to be less tiring. CONCLUSIONS: Restricting weight bearing status significantly increases energy expenditure; the PCI. FTWB may be a more tolerable form of restricted weight bearing, although the PCI does not reflect this perception. These findings should be borne in mind when recommending such restrictions in clinical practice and encouraging a patient to mobilise early and effectively.

Health-care costs associated with amputation or reconstruction of a limb-threatening injury.

BACKGROUND: Recent reports have suggested that functional outcomes are similar following either amputation or reconstruction of a severely injured lower extremity. The goal of this study was to compare two-year direct health-care costs and projected lifetime health-care costs associated with these two treatment pathways. METHODS: Two-year health-care costs were estimated for 545 patients with a unilateral limb-threatening lower-extremity injury treated at one of eight level-I trauma centers. Included in the calculation were costs related to (1) the initial hospitalization, (2) all rehospitalizations for acute care related to the limb injury, (3) inpatient rehabilitation, (4) outpatient doctor visits, (5) outpatient physical and occupational therapy, and (6) purchase and maintenance of prosthetic devices. All dollar figures were inflated to constant 2002 dollars with use of the medical service Consumer Price Index. To estimate projected lifetime costs, the number of expected life years was multiplied by an estimate of future annual health-care costs and added to an estimate of future costs associated with the purchase and maintenance of prosthetic devices. RESULTS: When costs associated with rehospitalizations and post-acute care were added to the cost of the initial hospitalization, the two-year costs for reconstruction and amputation were similar. When prosthesis-related costs were added, there was a substantial difference between the two groups ($81,316 for patients treated with reconstruction and $91,106 for patients treated with amputation). The projected lifetime health-care cost for the patients who had undergone amputation was three times higher than that for those treated with reconstruction ($509,275 and $163,282, respectively). CONCLUSIONS: These estimates add support to previous conclusions that efforts to improve the rate of successful reconstructions have merit. Not only is reconstruction a reasonable goal at an experienced level-I trauma center, it results in lower lifetime costs.

The lower-limb tasks questionnaire: an assessment of validity, reliability, responsiveness, and minimal important differences.

OBJECTIVES: To develop a questionnaire that focuses only on physical tasks related to lower-limb function and, within that questionnaire, to explore the psychometric properties of a series of questions that are related specifically to activities of daily living (ADLs) and a series of activities more often associated with recreation. DESIGN: Inception cohort. SETTING: Private practice. PARTICIPANTS: Data were primarily from patients who had experienced a lower-limb injury that would typically involve rehabilitation up to 6 weeks. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Through 5 studies, the following psychometric qualities were evaluated: content and factor validity, construct and concurrent validity, test-retest reliability (intraclass correlation coefficient [ICC], typical error), responsiveness (effect size, standardized response mean, Guyatt's responsiveness statistic), and the minimum important difference (distribution, anchor-based approaches). RESULTS: Factor analysis supported the theoretical perspective that ADLs and recreational activities can be treated as different domains within the construct of function. Internal consistency was high (Cronbach alpha: ADLs, .91; recreational activities, .95) and the 2 domains explained a moderate level of the response variance (61%). In the ADL domain, 7 tasks had greater than 80% of participants regarding them as having some importance. For recreational activities, 6 tasks had 79% or more of participants regarding them as having some importance. Both domains were moderately correlated to actual performance of tasks (r = .62, r = .72), and to other questionnaires used for lower-limb injuries (r range, .51-.86). The floor and ceiling effects of the domains followed an expected pattern that could be related to the loading forces experienced on the injured limb during activities. The reliability of the 2 domains was high (ICCs >.95), and the Bland-Altman plots showed that the distribution of error across the range of scores was random with low bias scores (<1.0 point). Typical error scores were 2 points for each domain. All measures of responsiveness were high (1.2-6.7). Measures of the minimal important difference varied (3-10 points) according to the methodologic approach used. CONCLUSIONS: The questionnaire possesses good factor structure and composition, relates well with other measures of function, differentiates patients with regard to certain characteristics or processes known to occur after injury, shows high levels of reliability and responsiveness, and shows evidence of good minimal important difference scores. The findings support the use of the questionnaire in both clinical scenarios and in research.

Demographic, social and economic variables that affect lower extremity injury outcomes.

While behavioral, demographic and vocational factors are commonly know as risk factors for sustaining a traumatic injury, less is known about the social, demographic and economic determinants of outcome following injury. The Lower Extremity Assessment Project (LEAP) identified a prospective cohort of 601 patients who were admitted to eight level I trauma centers in the United States for treatment of severe lower extremity trauma. Prospective data was accumulated on these individuals throughout their initial hospitalization and at regular follow-up intervals including a cohort at seven years post-injury. The results of the LEAP investigations showed that even at five to seven years following injury, reconstruction for the treatment of injuries to the lower extremity typically result in functional outcomes equivalent to those of the amputation. Clearly, factors other than the traditional variables such as fracture healing, joint function, and ability to ambulate have a profound effect on the patient's estimation of improvement. The purpose of this report is to summarize the data from the LEAP study and other investigations related to demographic, social and behavioral factors which impact outcome following lower extremity injury.

Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP).

The Lower Extremity Assessment Project (LEAP) is a multicenter study of severe lower extremity trauma in the US civilian population. At 2- and 7-year follow-ups, the LEAP study found no difference in functional outcome between patients who underwent either limb salvage surgery or amputation. However, outcomes on average were poor for both groups. This study and others provide evidence of wide-ranging variations in outcome following major limb trauma, with a substantial proportion of patients experiencing long-term disability. In addition, outcomes often are more affected by the patient's economic, social, and personal resources than by the initial treatment of the injury--specifically, amputation or reconstruction and level of amputation. A conceptual framework for examining outcomes after injury may be used to identify opportunities for interventions that would improve outcomes. Because of essential differences between the civilian and military populations, the findings of the LEAP study may correlate only roughly with combat casualty outcomes.

Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons.

Nonoperative treatment of acute or chronic complete ruptures of the proximal hamstring tendons leads to functional impairment in sports activities. The objective of the study was to evaluate the functional status after primary and delayed surgical treatment including objective (isokinetic hamstring and quadriceps muscle testing, hamstring flexibility) and subjective parameters (overall satisfaction, postoperative sports level). A total of eight patients (six male, two female) with an average age of 40.0 years (range 23-60) were treated operatively by refixation of the ruptured tendons in anatomical position using a suture anchor system. Six patients were treated within 3 weeks after trauma, while two patients were operated after delayed diagnosis of more than 2 months. The average clinical follow-up was 33.3 months (range 12-59). Overall, at minimum follow-up of 20 months, all patients were satisfied with the functional outcome and would undergo operative treatment again. At follow-up, seven patients could return to their preinjury sports level. In two patients, however, we noticed a delayed return to preinjury sports level of more than 24 months. The peak torque of the operated hamstrings in isokinetic muscle testing was 88.3% (range 62.9-113.8), as compared to the contralateral extremity. The ratio of hamstring to quadriceps muscle strength was on average 0.55 (range 0.44-0.66; injured side) versus 0.61 (range 0.52-0.68; uninjured side). Measurement of hamstring flexibility showed no difference to the contralateral hamstrings. In cases of timely diagnosis, surgical treatment is the standard treatment for complete ruptures of the proximal hamstring tendons in patients with ambitions inclined toward sports. The suture anchor system implements an elegant and effective technique for the treatment of such lesions.