Review Article

Hamstring Injuries in Athletes: Evidence-based Treatment

Arner, Justin W. MD; McClincy, Michael P. MD; Bradley, James P. MD

From the Department of Orthopaedic Surgery, University of Pittsburgh (Dr. Arner and Dr. McClincy), and Burke and Bradley Orthopedics, University of Pittsburgh Medical Center, UPMC St. Margaret (Dr. Bradley), Pittsburgh, PA.

Dr. Bradley has received royalties from Arthrex. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Arner and Dr. McClincy.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jaaos.org).

Journal of the American Academy of Orthopaedic Surgeons 27(23):p 868-877, December 1, 2019. | DOI: 10.5435/JAAOS-D-18-00741

SDC

Abstract

Hamstring injuries are common in athletes and can cause notable disability. They can be separated based on proximal, muscle belly, and distal injuries, with proximal and distal injuries more commonly requiring surgical intervention. Most injuries do not require acute MRI; however, MRI is useful in proximal and distal injuries as well as muscle belly tears that fail to respond to nonsurgical treatment. Acute repair of proximal avulsions, both partial and complete, result in successful outcomes, whereas chronic complete repairs are more difficult and less reliable. Muscle belly injuries have predictable outcomes but recurrence is common. Nonsurgical treatments focus on eccentric strengthening with the possible addition of low WBC platelet-rich plasma, which may have the potential to hasten recovery and decrease re-rupture. Distal injuries are relatively rare but may require surgical intervention. Hamstring reinjury is common, making continuation of preventive therapies after return to sport essential. Future research with larger sample sizes are required to determine how to decrease injury and reinjury rates, to evaluate the efficacy of platelet-rich plasma and to determine other treatments that may accelerate recovery after injury.