Treatment of proximal hamstring ruptures - a systematic review

Int J Sports Med. 2011 Jul;32(7):490-5. doi: 10.1055/s-0031-1273753. Epub 2011 May 11.


Proximal hamstring ruptures are increasingly treated surgically, despite little high-level supporting evidence. We sought to determine whether there are differences in clinical outcome after surgical vs. non-surgical treatment of proximal hamstring tendinous avulsions/ruptures and acute vs. chronic surgical repair of tendinous avulsions. Multiple medical databases were searched for Level I-IV evidence. 18 studies were included. 298 subjects (300 proximal hamstring injuries) were analyzed with mean age of 39.7 years. 286 injuries were managed with surgical repair vs. 14 non-operative. 95 surgical cases were performed within 4 weeks of the injury (acute), while 191 were performed beyond 4 weeks (chronic). 292 injuries were tendinous avulsions while 8 were bony tuberosity avulsions. Surgical repair resulted in significantly (p < 0.05) better subjective outcomes, greater rate of return to pre-injury level of sport, and greater strength/endurance than non-surgical management. Similarly, acute surgical repair had significantly better patient satisfaction, subjective outcomes, pain relief, strength/endurance, and higher rate of return to pre-injury level of sport than chronic repair (p < 0.001) with reduced risk of complications and re-rupture (p < 0.05). Chronic surgical repair also improves outcomes, strength and endurance, and return-to-sport, but not as well as acute repair. Non-operative treatment results in reduced patient satisfaction, with significantly lower rates of return to pre-injury level of sport and reduced hamstring muscle strength.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Athletic Injuries / physiopathology
  • Athletic Injuries / surgery
  • Athletic Injuries / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle Strength
  • Patient Satisfaction
  • Recovery of Function
  • Rupture / physiopathology
  • Rupture / surgery
  • Rupture / therapy*
  • Tendon Injuries / physiopathology
  • Tendon Injuries / surgery
  • Tendon Injuries / therapy*
  • Thigh
  • Treatment Outcome