Summary

This systematic review evaluated the rate at which patients return to sporting activities after surgical management of proximal hamstring ruptures, and showed that most patients returned to athletic participation, but there was a notable proportion that were unable to resume activity at a pre-injury level of competition.

Abstract

Objective

To assess the rates and timing of return to sport for the surgical management of proximal hamstring ruptures.

Methods

Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until October 7, 2017 by two reviewers independently and in duplicate. The inclusion criteria were studies reporting return to sport outcomes for surgical management of acute, chronic, complete, and partial proximal hamstring ruptures. Study quality was assessed using the methodological index for non-randomized studies (MINORS) criteria. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model.

Results

Overall, 21 studies with a total of 846 patients met the inclusion criteria, with a mean age of 41.4 years (range, 14 to 71 years), and a mean follow-up of 37.8 months (range, 6 to 76 months). Two studies were of prospective comparative design (Level II), 2 were retrospective comparative (level III), 7 were prospective case series (level IV), and 10 were retrospective case series (level IV). The overall mean time to return to sport was 5.8 months (range, 1 to 36 months). The pooled rate of return to any sport participation was 87% (95% confidence interval [CI] = 77% to 95%). The pooled rate of return to pre-injury level of sport was 77% (95% CI = 66% to 86%).

Conclusion

Pooled results suggest a high rate of return to sport following surgical management of proximal hamstring ruptures; however, this was associated with a lower pre-injury level of sport. No major differences in return to sport were found between partial versus complete and acute versus chronic proximal hamstring ruptures.