Return to Sport After Surgical Management of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis

To assess the rates and timing of return to sport for the surgical management of proximal hamstring avulsions (PHAs).

Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until October 7, 2017, by 2 reviewers independently and in duplicate. The inclusion criteria were studies reporting return to sport outcomes for surgical management of acute, chronic, complete, and partial PHA. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model.

Overall, 21 studies with a total of 846 patients met the inclusion criteria, with a mean age of 41.4 years (range, 14-71 years) and a mean follow-up of 37.8 months (range, 6-76 months). Two studies were of prospective comparative design (level II), 2 were retrospective comparative (level III), 8 were prospective case series (level IV), and 9 were retrospective case series (level IV). The overall mean time to return to sport was 5.8 months (range, 1-36 months). The pooled rate of return to any sport participation was 87% [95% confidence interval (CI), 77%-95%]. The pooled rate of return to preinjury level of sport was 77% (95% CI, 66%-86%).

Pooled results suggest a high rate of return to sport after surgical management of PHA; however, this was associated with a lower preinjury level of sport. No major differences in return to sport were found between partial versus complete and acute versus chronic PHA.