Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

Belk, John W.; Kraeutler, Matthew J.; Mei-Dan, Omer; Houck, Darby A.; McCarty, Eric C.; Mulcahey, Mary K.

doi:10.1177/2325967119853218

Cited by 18 publications

(23 citation statements)

References 28 publications

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“…Belk et al. [ 36 ] concluded in a systematic review that patients with partial and complete hamstring tears can be expected to return to sports at a similar rate after operative repair (partial 96.8% and complete 93.0%, p =.18), which was similar finding with the systematic review authored by Coughlin et al. [ 37 ].…”

Section: Discussionsupporting

confidence: 64%

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A systematic review of surgical intervention in the treatment of hamstring tendon ruptures: current evidence on the impact on patient outcomes

et al. 2022

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Hamstring injuries are among the most common muscle injuries. They have been reported in many different sports, such as running, soccer, track and field, rugby, and waterskiing. However, they are also present among the general population. Most hamstring injuries are mild strains, but also moderate and severe injuries occur. Hamstring injuries usually occur in rapid movements involving eccentric demands of the posterior thigh. Sprinting has been found to mainly affect the isolated proximal biceps femoris, whereas stretching-type injuries most often involve an isolated proximal injury of the semimembranosus muscle. The main cause of severe 2- or 3-tendon avulsion is a rapid forceful hip flexion with the ipsilateral knee extended. Most hamstring injuries are treated non-surgically with good results. However, there are also clear indications for surgical treatment, such as severe 2- or 3-tendon avulsions. In athletes, more aggressive recommendations concerning surgical treatment can be found. For a professional athlete, a proximal isolated tendon avulsion with clear retraction should be treated operatively regardless of the injured tendon. Surgical treatment has been found to have good results in severe injuries, especially if the avulsion injury is repaired in acute phase. In chronic hamstring injuries and recurring ruptures, the anatomical apposition of the retracted muscles is more difficult to be achieved. This review article analyses the outcomes of surgical treatment of hamstring ruptures. The present study confirms the previous knowledge that surgical treatment of hamstring tendon injuries causes good results with high satisfaction rates, both in complete and partial avulsions. Early surgical repair leads to better functional results with lower complication rates, especially in complete avulsions. KEY MESSAGEs Surgical treatment of hamstring tendon ruptures leads to high satisfaction and return to sport rates. Both complete and partial hamstring tendon ruptures have better results after acute surgical repair, when compared to cases treated surgically later. Athletes with hamstring tendon ruptures should be treated more aggressively with operative methods.

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Section: Discussionsupporting

confidence: 64%

“…Belk et al. [ 36 ] found that the early repair group had the quickest time to return to sports and the highest rate of return to sports, but statistical significance was not reached in neither of these outcomes. Coughlin et al.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of surgical intervention in the treatment of hamstring tendon ruptures: current evidence on the impact on patient outcomes

et al. 2022

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“…Belk et al 19 and Coughlin et al 3 performed systematic reviews to look specifically at return to sport after surgical treatment of proximal hamstring tears. 3 19 Both studies had similar conclusions suggesting a high rate of sport participation.…”

Section: Resultsmentioning

confidence: 99%

“…Their main outcome was a return to sport, which was achieved in the majority of patients treated surgically. 3 Belk (2019) 19 included 16 studies and had similar conclusions with a return to sport in greater than 90% of the patients having a hamstring repair.…”

Section: Current Evidencementioning

confidence: 94%

“…They concluded that there is a 'paucity of high-quality studies' and that acute surgically treated patients essentially have better outcomes. 9 Coughlin (2018) 3 and Belk (2019) 19 addressed the issue of returning to sport in their systematic reviews. Coughlin included 21 publications and performed both a quality assessment and meta-analysis of the available data.…”

Section: Current Evidencementioning

confidence: 99%

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Proximal hamstring tendon avulsion: state of the art

et al. 2021

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Complete proximal hamstring tendon avulsions from the ischial tuberosity, though infrequent, are the most severe type of hamstring muscle injury in the field of sport medicine. These serious injuries are commonly associated with a delayed or even misdiagnosis, despite obvious clinical findings. The published literature favours surgical repair even though the studies represent lower levels of evidence. Non-surgical treatment is a viable option for lower physical demand patients. This state-of-the-art article reviews the relevant anatomy, the clinical assessment including specific physical examination signs and diagnostic testing in patients suspected of a proximal hamstring avulsion. Up-to-date evidence is reviewed to address surgical and non-surgical treatment options and outcome assessment. The authors provide a detailed description of what would be considered the current worldwide standard of care; an open, suture-anchor-based repair of the avulsed tendon complex (semitendinosus, long head of biceps femoris and semimembranosus) securely to the ischial tuberosity. Also included are surgical tips and tricks, with advice on postsurgical management and rehabilitation. Future perspectives should involve higher quality, prospective research to better define the indications for surgery, evaluate the emerging role of endoscopic repair and disclose complications along with measuring patient-reported outcomes.

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