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Int J Sports Med 2011; 32(7): 490-495
DOI: 10.1055/s-0031-1273753
Review

© Georg Thieme Verlag KG Stuttgart · New York

Treatment of Proximal Hamstring Ruptures – A Systematic Review

J. D. Harris1 , M. J. Griesser1 , T. M. Best2 , T. J. Ellis1
  • 1The Ohio State University, Orthopaedics, Columbus, United States
  • 2The Ohio State University, Family Medicine, Columbus, United States
Further Information

Publication History

accepted after revision February 14, 2011

Publication Date:
11 May 2011 (online)

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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.

Key words

ischial tuberosity - semitendinosus rupture - semimembranosus rupture - biceps femoris rupture

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Correspondence

Dr. Joshua D HarrisMD 

The Ohio State University

Orthopaedics

2050 Kenny Road

43221 Columbus

United States

Phone: +1/614/293 2663

Fax: +1/614/293 4755

Email: Joshua.Harris@osumc.edu