Back in stride: patient perspectives on operative and nonoperative treatment and recovery after acute proximal hamstring avulsions – a qualitative study

Patient-reported outcome measures indicate favorable results after both operative and nonoperative treatment of acute proximal hamstring avulsions. However, little is known about the patients´ experience with treatment and recovery. The aim of this study was to explore the patient perspective on proximal hamstring avulsions, spanning the trajectory from injury through treatment and rehabilitation to the final outcome. Semi-structured interviews were conducted in groups with participants treated either operatively or nonoperatively for a proximal hamstring avulsion. Participants in the “Proximal Hamstring Avulsion Clinical Trial”, a parallel randomized controlled trial and observational cohort, were invited to take part in this focus group study. One focus group included participants who experienced persistent disabling neurological symptoms. Interviews were conducted 22–50 months after injury. The interviews were recorded and transcribed verbatim. The data were analyzed using Systemic Text Condensation. Eighteen participants from 30–70 years of age were divided into five focus groups. The inductive analysis led to the following five themes: Concern and uncertainty in the initial phase, Surgical versus nonsurgical treatment, Motivational factors, Physical and psychological sequelae, and “When things do not turn out as expected”. The latter theme was related to participants suffering persistent disabling neurological symptoms. Participants were overall satisfied with their treatment and motivated to return to pre-injury activities and mostly succeeded in doing so. However, most participants experienced lingering discomfort even years after injury. For those who suffered persistent disabling symptoms, quality of life remained significantly reduced. Experiences were similar across treatments, though surgical patients felt reassured everything had been done, while some nonsurgical patients wondered if surgery might have led to better results. The findings of this study provide valuable insights for patient education and improving management strategies for proximal hamstring avulsions.