Conservative Treatment of Total Proximal, Non-Avulsion, Hamstring Muscle - Rupture, in High Level Athletes

Abstract

BackgroundHamstring muscle injuries are notoriously found among the most common causes of abstinence and delayed return to sport, in a variety of track, field and other high level athletes. In this respect we present our experience of conservative treatment of total proximal, non-avulsed hamstring rupture in high-level track, field and other athletes and application of an integrated rehabilitation protocol.MethodsEleven high level athletes, nine men and two women, were diagnosed with sub/ total proximal, non-avulsed, hamstring rupture (grade III or IV strain). All of the patients were treated conservatively over a time scheme of twelve weeks.Then the athletes were ready to return to their complete sport–specific training.ResultsAll the athletes were treated conservatively. All of them made a full return to their sport .Mean follow up time was from six months to two years. One male track athlete had a multiple reinjury history after his primary hamstring rupture (over 18 months of follow up).All the other athletes fully returned to their sports with no recurrent hamstring injuries during the follow up.ConclusionsIndications that have been proposed for operative treatment of total proximal hamstring ruptures are most clear and widely acceptable when a bone avulsion is present off the ischial tuberosity.1However when it comes to total proximal, non avulsed ,hamstring rupture (grade III or IV strain) the operative indications may be relative and there still may be a place for integrated conservative treatment.2Conservative treatment has to be based on the correct classification of the injury, the right clinical assessment at the acute phase as well as along the whole length of treatment.Surgical treatment has an important role to play in complete proximal hamstring ruptures bearing in mind the right indications such as acute bone avulsions from the muscles’ origin.3

Outcome After Surgical Repair of Proximal Hamstring Avulsions

“…A previous systematic review done by Harris et al 22 reported a return to sports rate at a preinjury level of 82% following surgical repair but did not report data concerning hamstring strength, patient satisfaction rates, and functional outcome scales, which prevents further comparison. For comparison, Sallay et al 44 and Malliaropoulos et al 36 reported return to sports rates after nonoperative management of 58% and 100%, respectively. Studies included in our systematic review reported that surgical management of proximal hamstring avulsions leads to varying rates of return to sport (76%-100%) and return to preinjury activity level (55%-100%), high scores on functional outcome scales, and high patient satisfaction (88%-100%).…”

“…{ Nonoperative management of proximal hamstring avulsions mainly comprises rest, icing, and exercises with a gradual return to (athletic) activities 10 and appears to lead to conflicting results. Sallay et al 45 presented 12 cases, of which 58% returned to sports at a lower level, while Malliaropoulos et al 36 presented 11 high-level athletes with a 100% return to sports rate.…”

Suture Bridge Repair of Proximal Hamstring Avulsion: A Case Report

“…Sallay et al [9] reported on 12 cases of proximal hamstring avulsions treated nonoperatively with only 58% of individuals returning to sport, and all at a lower activity level. In a similar study, Malliaropoulos et al [10] reported on 11 high-level athletes treated nonoperatively with a 100% return to sport. In a systematic review, Harris et al [11] described a return to sport rate of 82% in operative groups versus only 14% in nonoperative groups.…”