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Outcomes After Operative and Nonoperative Treatment of Proximal Hamstring Avulsions: A Systematic Review and
Blake M Bodendorfer1, Andrew J Curley1, Joshua A Kotler2
1Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
The American Journal of Sports Medicine
|October 11, 2017
Summary
Surgical repair of proximal hamstring avulsions yields better patient satisfaction and strength compared to nonoperative treatment. Acute repairs show superior results over chronic ones, though complete avulsions have higher complication rates.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Musculoskeletal Research
Background:
- Proximal hamstring avulsions are injuries that can be treated operatively or nonoperatively.
- No previous meta-analysis has directly compared the outcomes of these two treatment approaches.
Purpose of the Study:
- To conduct a meta-analysis comparing outcomes of operative versus nonoperative treatment for proximal hamstring avulsions.
- To analyze results based on repair type: acute, chronic, partial, and complete.
Main Methods:
- A comprehensive literature search was performed across multiple databases (PubMed, CINAHL, SPORTdiscus, Cochrane Library, EMBASE, Web of Science) up to July 2016.
- Studies were screened, and quality assessed using the Methodologic Index for Nonrandomized Studies.
- A best-evidence synthesis approach was employed.
Main Results:
- Twenty-four studies with 795 proximal hamstring avulsions were included. Operative repair demonstrated significantly higher patient satisfaction (90.81% vs. 52.94%), hamstring strength (85.01% vs. 63.95%), and functional outcomes.
- Acute repairs outperformed chronic repairs in satisfaction, pain reduction, strength, and functional scores.
- Complete avulsion repairs showed higher satisfaction and less pain but also a higher complication rate (29.38%) compared to partial repairs.
Conclusions:
- Operative repair of proximal hamstring avulsions leads to superior outcomes compared to nonoperative management, despite a notable complication rate.
- Acute repairs are associated with better results than chronic repairs.
- High-quality studies are needed to further investigate the outcomes of proximal hamstring avulsion repairs.
