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Proximal hamstring tendon avulsion treatment choice depends on a combination of clinical and imaging-related factors: a worldwide survey on current clinical practice and decision-making
  1. Anne D van der Made1,2,3,4,
  2. Per Hölmich5,
  3. Gino M M J Kerkhoffs2,3,4,
  4. Vincent Gouttebarge2,3,4,6,
  5. Pieter D’Hooghe1,
  6. Johannes L Tol1,2,3,4
  1. 1 Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  3. 3 Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
  4. 4 Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
  5. 5 Department of Orthopaedic Surgery, Sports Orthopaedic Research Center – Copenhagen (SORC-C), Amager-Hvidovre University Hospital, Copenhagen, Denmark
  6. 6 Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Dr Johannes L Tol, Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Johannes.Tol{at}


Objectives To evaluate current practice in the treatment of proximal hamstring tendon avulsions and identify decision-making preferences.

Methods An invitation to an anonymous e-survey containing 32 questions was sent to 3475 members of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) and the European College of Sports and Exercise Physicians (ECOSEP).

Results We received 403 (12%) unique responses with a completion rate of 79%. Participants were orthopaedic/trauma surgeons (90%), sports medicine physicians (7%) or physical therapists (2%). For 83% of the participants, the preferred treatment (ie, surgical or non-operative) depends on the individual case. Participants base their decision-making process on patient- and injury-related factors (decision modifiers). The five most frequently selected decision modifiers that support the choice for surgical treatment were diminished function (84%), neurological symptoms (74%), involved tendons (82%), tendon retraction on MRI (84%) and patient preference for surgery (78%). The majority prefer early surgical repair (<2 weeks after injury) to achieve highest functional outcome (63%) and ensure a low complication risk (61%). Suture anchors are used by 93% of the participants for tendon reattachment. Estimated recovery duration (ie, time to return to sports) was a median 12 weeks (IQR: 12–20) for non-operative treatment and 17 weeks (IQR: 12–24) for surgical treatment. Estimated reinjury risk was a median 25% (IQR: 10–31.5) and 10% (IQR: 5–20), respectively.

Conclusion This survey among experienced medical professionals has summarised current practice and identified treatment decision-making preferences. The typical surgical patient has a retracted (>2 cm) two-tendon avulsion (ie, common tendon and semimembranosus tendon), is unable to engage in sports or activities of daily life, reports sciatic symptoms and prefers surgical treatment. Surgery is thought to prolong recovery and decrease reinjury risk compared with non-operative treatment and is preferably performed early.

Level of evidence Level V.

  • lower extremity
  • tears
  • tendon
  • orthopaedic sports medicine
  • treatment / technique

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  • Contributors All authors were involved in study development and writing/editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Exempted from ethics review by the local IRB (Anti-Doping Lab Qatar, ADLQ, Doha, Qatar).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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