Treatment of Proximal Hamstring Ruptures - A Systematic Review

Int J Sports Med. 2011 May 11.

Harris JD, Griesser MJ, Best TM, Ellis TJ.

Source

The Ohio State University, Orthopaedics, Columbus, United States.

Abstract

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.

Links also see below to papers / articles of interest

See also here for a review on Hamstring Injuries from Ortho Super Site


Acute proximal hamstring rupture paper 2007 MRI + Anatomical drawings

Elite Human Performance Centre

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Sports Medicine Indemnity Medico Legal Care Pro Sport Evening Meeting - Free

Sport & Exercise Medicine Professional Indemnity Scheme


INVITATION

7th June 2011, 6.00 – 8.00pm

Worsley Park Hotel & Country Club

Manchester M28 2QT

A compelling risk assessment by Neil Redman of SEMPRIS and Medico-Legal specialist Dr Gerard Panting of the liability, risks and indemnity issues facing doctors involved in the treatment, reporting and medical assessment of professional sportsmen & women.

Targeted principally at Radiologists, Cardiologists, Orthopaedic Specialists, Anaesthetists, and SEM Physicians, the short presentation will examine the risks and liabilities posed by the type of questions given below. Clarification will be provided on the ability of the traditional Medical Defence Organisations (MDOs) to respond to these risks, following the recent changes and withdrawal of key elements of their indemnity cover.

 Do you treat professional sportsmen / women?

 Do you provide medical services directly to a club/s?

 Are you using Waiver Letters with patients and or clubs?

 Are you in receipt of Waiver Letters from patients or clubs?

 Do you provide screening, medical reports or assessments directly for clubs?

 Do you have a contract/s, whether implied or actual, to provide services to a club/s?

 Do you provide screening, medical reports or assessments for contracted, third party providers?

 What is a ‘Subrogated Claim’ and will your current indemnity respond to a claim from a third party?

 What precedents can be drawn from the outcome of the El-Safty vs WBA FC case?

 Why have the MDU and MPS withdrawn cover in respect of third party claims?
Timetable of events:
6.00 – 6.30pm Registration

6.30 – 7.15pm Presentation and Q&A Session

7.15 – 8.00pm Refreshments

8.00pm Close



This event is kindly sponsored by Oaklands Hospital, part of Ramsay Healthcare.

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RSVP: If you would like to attend the presentation please email, fax, or telephone your confirmation together with details of colleagues who mat wish to attend with you to: info@sempris.co.uk or call Callum Payne on 0208 770 0333 or Fax: 0208 770 2194. Places are limited so please respond promptly to reserve your place.


Latest date for confirmation of attendance – 31st May 2011