Outcomes After Operative and Nonoperative Treatment of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis

Abstract

Proximal hamstring avulsion repair resulted in superior outcomes as compared with nonoperative treatment, although the complication rate was 23.17%. The nonoperative group was quite small, making a true comparison difficult. Acute repairs have better outcomes than do chronic repairs. Complete avulsion repairs had higher patient satisfaction, less pain, and a higher complication rate than partial avulsion repairs, although partial avulsion repairs had better hamstring strength and endurance. Studies of high methodological quality are lacking in terms of investigating the outcomes of proximal hamstring avulsion repairs.

Potential hamstring injury blind spot: we need to raise awareness of proximal hamstring tendon avulsion injuries

“…The current body of evidence, despite its limitations, indicates that surgical intervention yields better subjective and functional outcomes than a non-operative approach and thus surgical consultation should be considered. Moreover, a delayed diagnosis can also affect chances of a good outcome, since delayed intervention (ie, later than 47 or 88 weeks after injury) is reported to result in inferior outcome, and is considered to be more difficult for the surgeon 2. In addition, even if the patient and the doctor were to make a shared decision in favour of conservative treatment, an adequate conservative treatment protocol would be expected to produce favourable results compared with a missed diagnosis 8…”

Proximal Hamstring Injuries: Review of Operative and Nonoperative Management

“…However, careful examination of the outcomes associated with nonoperative treatment reveal consistent strength deficits and inferior clinical outcomes compared with operative management. [27][28][29] This, combined with the difficulties and inferior outcomes associated with chronic repair after attempts at nonoperative management, 30,35,74,75 have led some to advocate for more aggressive early surgical treatment of proximal hamstring avulsions. It is important to consider that proximal hamstring injuries occur along a spectrum and most of the published literature focuses specifically on complete avulsion injuries with 2 cm of tendon retraction.…”

“…45 In studies comparing nonoperative and operative management of complete proximal hamstring avulsions, patients with nonoperatively treated injuries consistently report decreased strength, lower return to sport rates, and lower subjective outcomes when compared with patients treated operatively. 27,28 When considering the outcomes of nonoperative management of proximal hamstring injuries, it is important to consider that these injuries occur along a spectrum. For acute, complete proximal hamstring avulsions, the previously outlined results are generally unfavorable.…”

“…[27][28][29][30][31][32][33][34][35] Qualitative and quantitative synthesis of the recent literature suggests that acute surgical management provides the most optimistic clinical outcomes for specific patients with complete proximal hamstring avulsions, while noting that surgical management is not without complication. 27,31 Despite the recent evidence, management of proximal hamstring injuries must occur on a case by case basis, taking into consideration the goals and risk profile of the individual patient as well as the spectrum of pathology that should not be considered in aggregate. The following will provide a comprehensive review on the management of proximal hamstring injuries with a brief overview of important anatomic and diagnostic considerations, aiming to highlight the best available evidence to help, guide, decision making during management of these challenging injuries.…”

Reconstruction of chronic proximal hamstring avulsion injuries using ipsilateral distal hamstring tendons results in good clinical outcomes and patient satisfaction

“…The second patient underwent a secondary operation at 14 months post-DISCUSSIONThe most important finding from the current study was that surgical reconstruction of chronic proximal hamstring tears employing an ipsilateral distal hamstring tendon autograft yielded good post-operative clinical outcomes and patient satisfaction. While surgical repair for proximal hamstring ruptures in the acute setting has demonstrated good patient outcomes[5,12], reconstruction for chronic ruptures has been less favourable. In the chronic setting, particularly for patients complaining of significant functional impairment and large tendon defects, late-stage proximal hamstring reconstruction using a free graft harvested from the ipsilateral distal hamstrings demonstrated encouraging clinical outcomes out to 24 months.Albeit a small case series and underpowered to show statistical improvement, the subjective PHAT and SF-12 outcomes at 24 months post-surgery in the current series were similar to that reported previously for acute and chronic proximal hamstring repair[3].…”