Hamstring Injuries in Athletes: Anatomy, Pathology, and Treatment

Hamstring injuries are common in athletes and result in missed time from sport and activities. Recurrent injury is a persistent issue. Injury location and severity dictate treatment. Complete acute proximal hamstring avulsions are typically treated successfully with open or endoscopic surgery, while partial avulsions commonly are initially treated nonsurgically. If required, surgical repair results in high patient-reported outcomes, satisfaction, and return to activities. Chronic complete proximal avulsions have less predictable outcomes. Myotendinous injuries are typically treated nonsurgically; however, lost time and reinjury are common. Distal myotendinous injuries can lead to greater delay in return to sport and higher reinjury rate than their proximal or midsubstance counterparts. Owing to this, there has been a recent interest in surgical repair, but historically nonsurgical treatment has been the standard. Distal hamstring avulsions require a thorough knee evaluation for isolated hamstring and/or concomitant injuries, with surgical treatment being determined based on injury pattern, including location and severity. Return to sport and activities require a graduated physical therapy program focused on restoring tissue length without excessive strain. Hamstring injury prevention programs are efficacious, but implementation and compliance are variable. The purpose of this study was to describe the current understanding of the anatomy, pathology, and treatment of hamstring injuries in athletes.