title: Treatment of proximal hamstring ruptures - a systematic review.
abstract: Proximal hamstring ruptures are increasingly treated surgically, despite little high-level supporting evidence. We sought to determine whether there are differences in clinical outcome after surgical vs. non-surgical treatment of proximal hamstring tendinous avulsions/ruptures and acute vs. chronic surgical repair of tendinous avulsions. Multiple medical databases were searched for Level I-IV evidence. 18 studies were included. 298 subjects (300 proximal hamstring injuries) were analyzed with mean age of 39.7 years. 286 injuries were managed with surgical repair vs. 14 non-operative. 95 surgical cases were performed within 4 weeks of the injury (acute), while 191 were performed beyond 4 weeks (chronic). 292 injuries were tendinous avulsions while 8 were bony tuberosity avulsions. Surgical repair resulted in significantly (p < 0.05) better subjective outcomes, greater rate of return to pre-injury level of sport, and greater strength/endurance than non-surgical management. Similarly, acute surgical repair had significantly better patient satisfaction, subjective outcomes, pain relief, strength/endurance, and higher rate of return to pre-injury level of sport than chronic repair (p < 0.001) with reduced risk of complications and re-rupture (p < 0.05). Chronic surgical repair also improves outcomes, strength and endurance, and return-to-sport, but not as well as acute repair. Non-operative treatment results in reduced patient satisfaction, with significantly lower rates of return to pre-injury level of sport and reduced hamstring muscle strength.
authors.affiliation: The Ohio State University, Orthopaedics, Columbus, USA. Joshua.Harris@osumc.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Harris
authors.forename: M J
authors.initials: MJ
authors.lastname: Griesser
authors.forename: T M
authors.initials: TM
authors.lastname: Best
authors.forename: T J
authors.initials: TJ
authors.lastname: Ellis
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D017060:Patient Satisfaction; D020127:Recovery of Function; D012421:Rupture / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D013708:Tendon Injuries / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D013848:Thigh; D016896:Treatment Outcome