Influence of Workers' Compensation Status on Functional Recovery and Return to Work After Proximal Hamstring Avulsion Surgery: A Matched Cohort Study.

Abstract

Background: While patients receiving workers' compensation (WC) often exhibit lower postoperative functional outcomes after orthopaedic surgery, this has not been completely explored with proximal hamstring avulsion injury (PHAI).

Purpose: To (1) investigate the impact of patients with WC status on the functional outcome of PHAI repair and (2) identify risk factors for worse outcomes after PHAI repair.

Study design: Cohort study; Level of evidence, 3.

Methods: This study focused on adults >18 years who underwent primary PHAI repair between 2008 and 2021 and had minimum 2-year follow-up data. Patients were divided into a WC group and a control group matched based on age, Tegner score, injury type (chronicity and tendon involved), and follow-up duration. The primary outcome measure was the Parisian Hamstring Avulsion Score (PHAS), with secondary outcomes including return-to-work metrics, activity levels measured by the Tegner and University of California at Los Angeles scores, and complications. The association between WC status and having worse postoperative outcomes (work changes, PHAS scores in the bottom 25% of cases, delayed return to work, or complications) was assessed, and the model that showed a statistically significant association with WC status was included in a multivariate analysis to adjust for confounders.

Results: Overall, 104 patients (51 WC and 53 controls), with a mean age of 49.56 ± 9 years and a mean follow-up of 58.99 ± 44.61 months, were included. PHAS scores improved significantly after repair in both groups, yet WC patients exhibited lower postoperative PHAS scores (158.78 ± 34.43) than did control patients (171.77 ± 32.17; P = .049). Regression analysis revealed that patients with WC had a significantly higher risk of scoring in the bottom 25% (<150.75) on the PHAS (odds ratio [OR], 2.81 [95% CI, 1.09-7.28]; P = .033). On multivariate analysis, injury chronicity emerged as a significant risk factor for PHAS scores of <150.75 (OR, 8.09 [95% CI, 2.07-31.59]; P = .003), while the direct impact of the WC status was reduced (OR, 2.13 [95% CI, 0.75-6.07]; P = .155).

Conclusion: The lower functional outcomes seen in patients with WC were not significant after adjusting for confounders, with injury chronicity being the key factor affecting postoperative results. No association was detected between WC status and return-to-work metrics.