{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T20:09:09Z","timestamp":1778098149386,"version":"3.51.4"},"reference-count":21,"publisher":"BMJ","issue":"9","funder":[{"name":"Centrum f\u00f6r Idrottsforskning","award":["P2019-0155"],"award-info":[{"award-number":["P2019-0155"]}]},{"name":"\u00d6sterg\u00f6tland County Council"},{"DOI":"10.13039\/501100002706","name":"AFA F\u00f6rs\u00e4kring","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002706","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Landstingets \u00d6msesidiga F\u00f6rs\u00e4kringsbolag"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,8,1]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The treatment of proximal hamstring avulsions is controversial. While several trials have investigated the outcome for patients treated surgically, there is today no prospective trial comparing operative treatment with non-operative treatment. This protocol describes the design for the proximal hamstring avulsion clinical trial (PHACT)\u2014the first randomised controlled trial of operative versus non-operative treatment for proximal hamstring avulsions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>PHACT is a multicentre randomised controlled trial conducted across Sweden, Norway and Finland. Eligible patients (60 participants\/treatment arm) with a proximal hamstring avulsion of at least two of three tendons will be randomised to either operative or non-operative treatment. Participants allocated to surgery will undergo reinsertion of the tendons with suture anchors. The rehabilitation programme will be the same for both treatment groups. When patient or surgeon equipoise for treatment alternatives cannot be reached and randomisation therefore is not possible, patients will be invited to participate in a parallel observational non-randomised cohort. The primary outcome will be the patient-reported outcome measure Perth hamstring assessment tool at 24 months. Secondary outcomes include the Lower Extremity Functional Score, physical performance and muscle strength tests, patient satisfaction and MR imaging. Data analysis will be blinded and intention-to-treat analysis will be preformed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval has been granted by the Ethical Committee of Uppsala University (DNR: 2017\u2013170) and by the Norwegian ethical board (REC: 2017\/1911). The study will be conducted in agreement with the Helsinki declaration. The findings will be disseminated in peer-reviewed publications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03311997\">NCT03311997<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-031607","type":"journal-article","created":{"date-parts":[[2019,9,13]],"date-time":"2019-09-13T16:45:33Z","timestamp":1568393133000},"page":"e031607","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["The proximal hamstring avulsion clinical trial (PHACT)\u2014a randomised controlled non-inferiority trial of operative versus non-operative treatment of proximal hamstrings avulsions: study protocol"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"nct03311997","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2387-6721","authenticated-orcid":false,"given":"Elsa","family":"Pihl","sequence":"first","affiliation":[{"name":"Karolinska Institutet Danderyds Sjukhus, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00e5lfrid Holen","family":"Kristoffersen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne-Mari","family":"Rosenlund","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia","family":"Laszlo","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mida","family":"Bergl\u00f6f","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Danderyds Sjukhus, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Ribom","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Eriksson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education S\u00f6dersjukhuset, Karolinska Institute, Stockholm, Sweden"},{"name":"Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frede","family":"Frihagen","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ville M","family":"Mattila","sequence":"additional","affiliation":[{"name":"Department of Orthopeadics, Tampere University Hospital, Tampere, Finland, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Schilcher","sequence":"additional","affiliation":[{"name":"Department of Orthopeadic Surgery, Link\u00f6ping University Hospital, Linkoping, Sweden"},{"name":"Department of Clinical and Experimental Medicine, Link\u00f6ping University Hospital, Link\u00f6ping, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Eklund","sequence":"additional","affiliation":[{"name":"Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greta","family":"Snellman","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikael","family":"Skorpil","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olof","family":"Sk\u00f6ldenberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl Johan","family":"Hedbeck","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Danderyds Sjukhus, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,9,13]]},"reference":[{"key":"2025121601123968000_9.9.e031607.1","doi-asserted-by":"crossref","unstructured":"Bodendorfer BM , Curley AJ , Kotler JA , et al . Outcomes after operative and Nonoperative treatment of proximal hamstring Avulsions: a systematic review and meta-analysis. Am J Sports Med 2017;363546517732526.","DOI":"10.1177\/0363546517732526"},{"key":"2025121601123968000_9.9.e031607.2","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1007\/s00167-013-2744-0","article-title":"The hamstring muscle complex","volume":"23","author":"van der Made","year":"2015","journal-title":"Knee Surgery, Sports Traumatology, Arthroscopy"},{"key":"2025121601123968000_9.9.e031607.3","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512453298"},{"key":"2025121601123968000_9.9.e031607.4","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.01074"},{"key":"2025121601123968000_9.9.e031607.5","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513499518"},{"key":"2025121601123968000_9.9.e031607.6","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1007\/s00167-016-4214-y","article-title":"Proximal hamstring tendon avulsion surgery: evaluation of the Perth hamstring assessment tool","volume":"25","author":"Blakeney","year":"2017","journal-title":"Knee Surgery, Sports Traumatology, Arthroscopy"},{"key":"2025121601123968000_9.9.e031607.7","article-title":"Better Reporting of Interventions: Template for Intervention Description and Replication (TIDieR) Checklist and Guide]","volume":"78","author":"Hoffmann","year":"2016","journal-title":"Gesundheitswesen"},{"key":"2025121601123968000_9.9.e031607.8","first-page":"506","article-title":"Spirit 2013 statement: defining standard protocol items for clinical trials","volume":"38","author":"Chan","year":"2015","journal-title":"Rev Panam Salud Publica"},{"key":"2025121601123968000_9.9.e031607.9","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2311-0"},{"key":"2025121601123968000_9.9.e031607.10","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1007\/s00167-017-4475-0","article-title":"A prospective evaluation of proximal hamstring tendon avulsions: improved functional outcomes following surgical repair","volume":"25","author":"Blakeney","year":"2017","journal-title":"Knee Surgery, Sports Traumatology, Arthroscopy"},{"key":"2025121601123968000_9.9.e031607.11","first-page":"371","article-title":"The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. North American orthopaedic rehabilitation research network","volume":"79","author":"Binkley","year":"1999","journal-title":"Physical therapy"},{"key":"2025121601123968000_9.9.e031607.12","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2016.6165"},{"key":"2025121601123968000_9.9.e031607.13","doi-asserted-by":"publisher","DOI":"10.1249\/01.MSS.0000078924.61453.FB"},{"key":"2025121601123968000_9.9.e031607.14","doi-asserted-by":"crossref","unstructured":"Lee PH , Macfarlane DJ , Lam TH , et al . Validity of the International physical activity questionnaire short form (IPAQ-SF): a systematic review. International Journal of Behavioral Nutrition and Physical Activity 2011;8.doi:10.1186\/1479-5868-8-115","DOI":"10.1186\/1479-5868-8-115"},{"key":"2025121601123968000_9.9.e031607.15","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2013.4372"},{"key":"2025121601123968000_9.9.e031607.16","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20060143"},{"key":"2025121601123968000_9.9.e031607.17","doi-asserted-by":"crossref","first-page":"689","DOI":"10.2519\/jospt.2016.6363","article-title":"Strength measurements in acute hamstring injuries: Intertester reliability and prognostic value of handheld dynamometry","volume":"46","author":"Reurink","year":"2016","journal-title":"J Orthop Sports Phys Ther"},{"key":"2025121601123968000_9.9.e031607.18","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-003-0933-0"},{"key":"2025121601123968000_9.9.e031607.19","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-972605"},{"key":"2025121601123968000_9.9.e031607.20","first-page":"160","article-title":"Surgical Refixation after Proximal Hamstring Tendon Avulsion Injuries: Does the Time of Surgery Influence Functional Outcomes?]","volume":"31","author":"Best","year":"2017","journal-title":"Sportverletzung Sportschaden : Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin"},{"key":"2025121601123968000_9.9.e031607.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-031607","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:12:51Z","timestamp":1765876371000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-031607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,9,13]]},"published-print":{"date-parts":[[2019,9]]}},"alternative-id":["10.1136\/bmjopen-2019-031607"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-031607","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]}}}