Evaluation and management of hamstring injuries

Am J Sports Med. 2013 Dec;41(12):2933-47. doi: 10.1177/0363546513487063. Epub 2013 May 23.


Muscle injuries are the most common injuries in sports, with hamstring injuries accounting for 29% of all injuries in athletes. These injuries lead to prolonged impairment and have a reinjury risk of 12% to 31%. They range from mild muscle damage without loss of structural integrity to complete muscle tearing with fiber disruption. Novel MRI scores are increasingly being used and allow a more precise prediction of return to sport. In this article, the authors review the history, mechanisms of injury, and classification systems for hamstring injuries as well as present the latest evidence related to the management of hamstring injuries, including intramuscular and both proximal and distal insertional injuries. Indications for surgical treatment of certain proximal and distal avulsions, biological augmentation to the nonoperative treatment of midsubstance injuries, and advances in risk reduction and injury prevention are discussed.

Keywords: biceps femoris; cell therapy; distal hamstring resection; hamstring; hamstring injury prevention; platelet-rich plasma; proximal hamstring repair; semimembranosus; semitendinosus.

Publication types

  • Review

MeSH terms

  • Adult
  • Athletic Injuries / surgery
  • Athletic Injuries / therapy*
  • Female
  • Humans
  • Leg Injuries / surgery
  • Leg Injuries / therapy*
  • Magnetic Resonance Imaging
  • Male
  • Muscle, Skeletal / injuries*
  • Muscle, Skeletal / surgery
  • Sprains and Strains / surgery
  • Sprains and Strains / therapy*
  • Tendon Injuries / surgery
  • Tendon Injuries / therapy*
  • Young Adult