A systematic review of surgical intervention in the treatment of hamstring tendon ruptures: current evidence on the impact on patient outcomes

Figures & data

Figure 1. Selection process for included studies.

Table 1. Inclusion and exclusion criteria for publications.

Criteria	Description
Inclusion	Published in a peer-reviewed journal in 2005 or later
	Studies that investigated surgically treated ruptures of BF, SM, ST or any combination confirmed intraoperatively and/or with US or MRI
	Studies that included patients aged 18 years or more
	Studies that had used at least one clinical or patient-reported outcome measure in follow-up
Exclusion	Studies that were not published in English
	Studies that included <15 patients
	Systematic and non-systematic reviews

Table 2. All studies included for the review^a.

Study	Age, years	Professional athletes (%)	Competitive athletes (%)	Recreational athletes (%)	Follow-up, months	Complete/ partial	Acute/ chronic	Outcome measures
Lempainen et al. [10]	33 (16–61)	13 (27.1)	15 (31.3)	19 (39.6)	36	0/48	6/42	Satisfaction, RTS
Sarimo et al. [15]	46 (18–71)	0	2 (4.9)	27 (65.9)	37	41/0	14/27	Satisfaction
McGregor et al. [28]	Men, acute: 31.4; men, chronic: 28.8; women, acute: 33; women, chronic: 34	NR	NR	NR	NR	22/7	12/17	RTS, VAS
Wood et al. [29]	40.2 (12.9–66.2)	NR	NR	NR	24	65/7	65/7	Strength, endurance, RTS
Birmingham et al. [32]	46 (19–65)	NR	NR	NR	43.3	23/0	9/14	Single-legged hop, strength, endurance
Cohen et al. [7]	47.7 (17–66)	NR	NR	NR	33	38/14	40/12	LEFS, C-LEFS, Marx, C-Marx, RTS, strength
Lefevre et al. [20]	39.3 (±11.4)	3 (8.8)	12 (35.3)	17 (50.0)	27.2	23/11	34/0	UCLA, Tegner, RTS, strength, satisfaction
Skaara et al. [11]	51	0	5 (16.1)	26 (83.9)	30	17/14	28/3	LEFS, PHIQ, strength, single-legged hop, RTS
Rust et al. [19]	Acute: 49.8 (25–74), chronic: 40.7 (14–62)	NR	NR	NR	45	72/0	51/21	SANE, SF-12, VAS, satisfaction
Barnett et al. [21]	42.5	NR	NR	NR	53.8	96/36	38/94	Strength, endurance, RTS, satisfaction
Subbu et al. [18]	29 (18–52)	0	112 (100)	0	12	112/0	78/24	RTS
Blakeney et al. [22]	50.5 (16–74)	NR	NR	NR	12	49/22	37/37	PHAT, SF-12, LEFS
Blakeney et al. [14]	50 (16–74)	NR	NR	NR	34	64/29	49/47	PHAT, VAS, RTS
Arner et al. [26]	47.3 (16–65)	1 (1.6)	4 (6.3)	59 (92.2)	78	0/64	36/28	LEFS, Marx, C-LEFS, C-Marx, strength, RTS, satisfaction
Best et al. [24]	NR	NR	NR	NR	28	NR	49/0	PHAT, C-LEFS, C-Marx
Bowman et al. [25]	51.1 (17–77)	NR	NR	NR	29	45/13	38/20	SANE, iHOT-12, KJOC Athletic Hip Score, satisfaction, VAS, Tegner, RTS
Pihl et al. [23]	51 (34–68)	NR	NR	31 (93.9)	49	29/4	NR	LEFS, PHIQ, VAS, satisfaction
Aldridge et al. [34]	42 (25–58)	NR	NR	NR	37.2	0/23	NR	VAS, RTS, satisfaction, strength, endurance
Wood et al. [31]	49.2 (21.5–74.4)	8 (5.1)	13 (8.3)	69 (44.2)	60	110/46	82/74	SHORE, PHAT
Kurowicki et al. [27]	46.2 (18–63)	0	0	20 (100)	NR	NR	NR	PROM, strength, VAS, UCLA, mHHS
Irger et al. [33]	49 (±13)	NR	NR	136 (51.7)	NR	208/55	213/50	NR
Kayani et al. [17]	26	34 (100)	0	0	24	34/0	34/0	RTS, satisfaction, ROM, strength, PROM, LEFS, Marx
Kayani et al. [13]	38.7	14 (34.1)	0	27 (65.9)	NR	0/41	0/41	RTS, satisfaction, ROM, strength, PROM, LEFS, Marx
Fletcher et al. [30]	52 (19–77)	1 (3.3)	3 (10.0)	18 (60.0)	44	17/13	2/29	iHOT-12, SANE, mHHS, HOS-ADL, RTS, satisfaction
Total	43.9	74 (12.2)	166 (27.3)	449 (49.6)	35.9	991/425	858/482	RTS (15/24), satisfaction (12/24), strength (9/24), LEFS (7/24), VAS (7/24), Marx (4/24), PHAT (4/24), endurance (4/24), C-LEFS (3/24), C-Marx (3/24), SANE (3/24), PROM (3/24), ROM (2/24), iHOT-12 (2/24), Tegner (2/24), PHIQ (2/24), SF-12 (2/24), UCLA (2/24), single-legged hop (2/24), mHHS (2/24), HOS-ADL (1/24), SHORE (1/24), KJOC Athletic Hip Score (1/24)

HOS-ADL: Hip Outcome Score, Activities of Daily Living; iHOT: International Hip Outcome Tool; KJOC: Kerlan-Jobe Orthopaedic Clinic; LEFS: Lower Extremity Functional Scale; mHHS: modified Harris Hip Score; NR: not reported; PHAT: Perth Hamstring Assessment Tool; PHIQ: Proximal Hamstring Injury Questionnaire; PROM: passive range of motion; ROM: range of motion; RTS: return to sport; SANE: Single Assessment Numeric Evaluation; SF-12: 12-Item Short Form Survey; SHORE: Sydney Hamstring Origin Rupture Evaluation; UCLA: University of California, Los Angeles; VAS: visual analogue scale.

^a Data are represented as a mean ± SD or mean (range).

Table 3. Complications for operatively treated hamstring avulsions.

	Incidence, %	No.
Rerupture	0.69	11
Reoperation	0.50	8
Infection/wound complications	2.21	35
Neurologic complications	3.91	62
Peri-incisional numbness	2.65	42
DVT/PE	0.57	9
Miscellaneous	5.17	82
Total	15.69	249

Table 4. Complications for operatively treated acute and chronic hamstring avulsions.

	Acute, %	No.	Chronic, %	No.
Rerupture			1.06	2
Reoperation	0.33	1
Infection/wound complications	1.99	6	1.06	2
Neurologic complications	1.66	5	9.04	17
Peri-incisional numbness	5.32	16	2.13	4
DVT/PE	0.66	2	1.06	2
Miscellaneous	3.99	12	10.64	20
Total	13.95	42	25.00	47

Table 5. Complications for operatively treated partial and complete hamstring avulsions.

	Partial, %	No.	Complete, %	No.
Rerupture	0.45	1	1.02	4
Reoperation	1.81	4	0.77	3
Infection/wound complications	2.71	6	3.57	14
Neurologic complications	3.17	7	8.67	34
Peri-incisional numbness	2.71	6	3.57	14
DVT/PE	0.90	2	0.77	3
Miscellaneous	9.95	22	6.12	24
Total	21.72	48	24.49	96

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Data availability statement

Data sharing is not applicable to this article as no new data were created or analysed in this study.