Treatment of proximal hamstring ruptures - a systematic review

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Musculoskeletal Research

Background:

• Proximal hamstring ruptures are increasingly managed surgically, yet high-level evidence is limited.
• Understanding the comparative efficacy of surgical versus non-surgical interventions is crucial for clinical decision-making.
• Differentiating outcomes between acute and chronic surgical repairs is essential for optimizing patient recovery.

Purpose of the Study:

• To compare clinical outcomes between surgical and non-surgical treatments for proximal hamstring ruptures.
• To evaluate the differences in outcomes between acute and chronic surgical repairs of proximal hamstring avulsions.
• To synthesize existing evidence on the management of proximal hamstring injuries.

Main Methods:

• A systematic review of Level I-IV evidence was conducted across multiple medical databases.
• Included studies analyzed 298 subjects with 300 proximal hamstring injuries.
• Data on surgical (acute vs. chronic) and non-operative management were extracted and analyzed.

Main Results:

• Surgical repair demonstrated significantly better subjective outcomes, return to sport, and strength compared to non-surgical management (p < 0.05).
• Acute surgical repair (within 4 weeks) showed significantly superior patient satisfaction, outcomes, pain relief, strength, and return to sport versus chronic repair (p < 0.001).
• Non-operative treatment resulted in reduced patient satisfaction and lower rates of return to pre-injury sport and hamstring strength.

Conclusions:

• Surgical intervention for proximal hamstring ruptures leads to superior clinical outcomes compared to non-operative management.
• Early surgical repair (acute) is associated with better patient outcomes and functional recovery than delayed repair (chronic).
• While chronic surgical repair improves outcomes, it is less effective than acute repair, highlighting the importance of timely intervention.