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Treatment of Distal Hamstring Tendon Injuries: A Systematic Review

Description

Purpose: To compare the patient-reported outcomes and return to sports of the conservative and surgical treatment of distal hamstring tendon injuries.


Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers searched PubMed, Scopus, and Virtual Health Library databases in January 2023. Clinical studies evaluating conservative or surgical management outcomes of distal hamstring tendon injuries were considered eligible for this systematic review if predefined criteria were fulfilled: (1) published in English or Spanish; (2) evaluated any of the following: patient-reported outcomes, return-to-sports rate, or return-to-sports time. Data were presented in tables using absolute values from individual studies and derived pooled percentages.


Results: Eighteen studies were included for 67 patients and 68 distal hamstring tendon injuries. Initially, 39 patients (58.2%) underwent surgical treatment, while 28 (41.8%) were treated conservatively. Among conservative treatment patients, 15 failed and had to be operated on (53.6%), all with distal semitendinosus tendon injuries. Anchor fixation was the technique of choice in 20 lesions (36.4%), tenodesis in 16 (29.1%), tenectomy in 14 (25.5%), and sutures were preferred in 5 (9%). Thirteen out of 28 patients (46.4%) undergoing initial conservative treatment returned to sports at a mean of 3.6 months (range 1 week to 12 months), in contrast to surgical treatment, in which 36 out of 39 patients (92.3%) returned at a mean of 4.2 months (range 6 weeks to 12 months). Additionally, 14 of 15 patients (93.3%) converted to surgical treatment after failed conservative treatment returned to sports at a mean of 7.6 months after injury.


Conclusion: Initial surgical treatment of distal hamstring tendon injuries yields a high RTS-R (92.3%) at a mean of 4.2 months. Furthermore, 15 out of 28 patients (53.6%) initially treated conservatively had to be operated on, delaying the RTS-T (mean 7.6 months after injury) without affecting their RTS-R.

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Author

Theodorakys Marín Fermín

Sports Orthopaedic Surgeon

Centro Médico Profesional Las Mercedes

G A

Ghislain Aminake

Sports Surgery Fellow

Aspetar Orthopaedic and Sports Medicine Hospital

Angelo V. Vasiliadis, MD, PhD

Angelo V. Vasiliadis

Orthopaedic Surgeon

St. Luke's Hospital

G K

Georgios Kalifis

Orthopaedic Surgeon

St. Luke's Hospital

R G

Radoslaw Grabowski

Sports Orthopaedic Surgeon

SPORTO Clinic

L M

Luca Macchiarola

Sports Orthopaedic Surgeon

Ospedale Casa Sollievo della Sofferenza

A A

Ayyoub Al-Dolaymi

Aspetar Orthopaedic and Sports Medicine Hospital

ESSKA Continuous Professional Education Partners