Editorial Commentary: Repair of Proximal Hamstring Injuries Leads to Good Outcomes in Most Patients, but Higher Level of Evidence Suggests We Might Not Need to Repair Them All in the First Place.

Abstract

Hamstring injuries are common injuries in recreational and professional athletes. Treatment of these injuries depends on various factors, including age, activity level, type of sport, and tear location such as proximal, myotendinous, muscle, or distal injuries. Proximal hamstring avulsion injuries are a different type of injury and symptoms can consist of cramping, pain, weakness, or even sciatic nerve symptoms. Over the last decade, Level III and IV retrospective cohort studies and case series have suggested an increasing role for operative repair, using either an open, endoscopic, or combined ("scopen") approach. More recently, studies have focused on ideal selection criteria for open repair and assessed factors such as age, retraction, activity level, partial versus complete tears, timing, failure of physical therapy, and whether the semimembranosus, semitendinosus, biceps femoris, or combination with conjoined tendon are involved. Overall, outcomes following surgical reattachment are encouraging and patient satisfaction is high with return to sports rates ranging between 60% and 100%. Emerging prospective cohort studies and randomized controlled trials with low crossover rates suggest that nonoperative treatment might lead to equivalent results to operative treatment, so a thorough discussion with patients on both treatments is important for these injuries.