Outcome After Surgical Repair of Proximal Hamstring Avulsions: A Systematic Review.
BACKGROUND
At the present time, no systematic review, including a quality assessment, has been published about the outcome after proximal hamstring avulsion repair.


OBJECTIVE
To determine the outcome after surgical repair of proximal hamstring avulsions, to compare the outcome after acute (≤4 weeks) and delayed repairs (>4 weeks), and to compare the outcome after different surgical techniques.


METHODS
Systematic review and best-evidence synthesis.


METHODS
PubMed, CINAHL, SPORTdiscus, Cochrane library, EMBASE, and Web of Science were searched (up to December 2013) for eligible studies. Two authors screened the search results separately, while quality assessment was performed by 2 authors independently using the Physiotherapy Evidence Database (PEDro) scale. A best-evidence synthesis was subsequently used.


RESULTS
Thirteen studies (387 participants) were included in this review. There were no studies with control groups of nonoperatively treated proximal hamstring avulsions. All studies had a low methodological quality. After surgical repair of proximal hamstring avulsion, 76% to 100% returned to sports, 55% to 100% returned to preinjury activity level, and 88% to 100% were satisfied with surgery. Mean hamstring strength varied between reporting studies (78%-101%), and hamstring endurance and flexibility were fully restored compared with the unaffected side. Symptoms of residual pain were reported by 8% to 61%, and reported risk of major complications was low (3% rerupture rate). No to minimal difference in outcome was found between acute and delayed repair in terms of return to sports, patient satisfaction, hamstring strength, and pain. Achilles allograft reconstruction and primary repair with suture anchors led to comparable results.


CONCLUSIONS
The quality of studies included is low. Surgical repair of proximal hamstring avulsions appears to result in a subjective highly satisfying outcome. However, decreased strength, residual pain, and decreased activity level were reported by a relevant number of patients. Minimal to no differences in outcome of acute and delayed repairs were found. Limited evidence suggests that an Achilles allograft reconstruction yields results comparable with primary repair in delayed cases where primary repair is not possible. High-level studies are required to confirm these findings.
Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands a.d.vandermade@amc.uva.nl g.m.kerkhoffs@amc.uva.nl.
Anne D
AD
van der Made
Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Gustaaf
G
Reurink
Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Vincent
V
Gouttebarge
Department of Sports Medicine, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
Johannes L
JL
Tol
Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands a.d.vandermade@amc.uva.nl g.m.kerkhoffs@amc.uva.nl.
Gino M
GM
Kerkhoffs
D000125:Achilles Tendon / Q000293:injuries; D006801:Humans; D018482:Muscle, Skeletal / Q000293:injuries / Q000601:surgery*; D017060:Patient Satisfaction; D020127:Recovery of Function; D012421:Rupture / Q000601:surgery; D053441:Suture Anchors; D013708:Tendon Injuries / Q000601:surgery*; D014184:Transplantation, Homologous
Hamstring; avulsion; biceps femoris; hamstring origin; ischial tuberosity; rupture; semimembranosus; semitendinosus