Outcomes After Operative and Nonoperative Management of Hamstring Injuries: A Systematic Review.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Rehabilitation Science

Background:

• Hamstring injuries are prevalent in athletes participating in sports requiring acceleration and directional changes.
• Current management of hamstring injuries lacks standardized, evidence-based protocols, relying heavily on clinical judgment.
• The absence of clear guidelines hinders optimal patient recovery and return to sport.

Purpose of the Study:

• To systematically compare the effectiveness of operative versus nonoperative treatments for acute hamstring injuries.
• To evaluate outcomes including patient satisfaction, muscle strength, range of motion (ROM), and return to sport.
• To identify potential complications associated with each treatment approach.

Main Methods:

• A systematic review was conducted following PRISMA guidelines, searching major databases (PubMed, Google Scholar, Web of Science, ScienceDigest) from January 2000 to May 2024.
• Included studies focused on adult patients with acute hamstring injuries, assessing outcomes like muscle strength, ROM, functional activity, pain, and patient satisfaction.
• Thirteen eligible studies involving 526 patients were analyzed, with a focus on operative interventions, nonoperative management, and direct comparisons.

Main Results:

• Operative treatment demonstrated superior functional recovery, with high muscle strength (near 90% of contralateral limb) and improved functional activity scores (Tegner Activity Scale, Marx Activity Rating Scale).
• Range of motion (ROM) was preserved post-surgery, though not consistently evaluated in nonoperative groups. Nonoperative management showed a decline in activity scores.
• Complications were more frequent with surgery (4.2%-36.6%) but generally minor (hematomas, infections); nonoperative complications were limited to ecchymosis.

Conclusions:

• Operative hamstring injury management is associated with better functional recovery, muscle strength, and higher return-to-sport rates.
• While surgical complications exist, they are often minor and do not negate the overall benefits compared to nonoperative approaches.
• Further research with standardized measures is needed to define optimal patient selection for operative versus nonoperative hamstring injury treatment.