Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Feb 23;12(2):23259671241230045.
doi: 10.1177/23259671241230045. eCollection 2024 Feb.

Systematic Review of Bracing After Proximal Hamstring Repair

Phillip B Wyatt  1 , Tiffany D Ho  1 , Haleigh M Hopper  1 , James R Satalich  2 , Conor N O'Neill  2 , John Cyrus  1 , Alexander R Vap  2 , Robert O'Connell  2
Affiliations
Review

Systematic Review of Bracing After Proximal Hamstring Repair

Phillip B Wyatt et al. Orthop J Sports Med. .

Abstract

Background: Traditionally, postoperative rehabilitation protocols after proximal hamstring repair (PHR) for avulsion of the proximal hamstring tendon from its ischial insertion recommend bracing the hip and/or knee to protect the fixation. However, because of the cumbersome nature of these orthoses, recent studies have investigated outcomes in patients with postoperative protocols that do not include any form of postoperative bracing.

Purpose: To synthesize the current body of evidence concerning bracing versus nonbracing postoperative management of PHR.

Study design: Systematic review; level of evidence, 4.

Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a thorough search of the PubMed/Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase (OVID) databases on March 24, 2023. We analyzed complication rates, reoperation rates, patient satisfaction, return to sport, and patient-reported outcomes of studies that used postoperative bracing versus studies that used no postoperative bracing after PHR with at least 12 months of follow-up. A total of 308 articles were identified after initial search.

Results: In total, 25 studies were included in this review: 18 studies (905 patients) on bracing and 7 studies (291 patients) on nonbracing after PHR. The overall complication rate in the braced patients was found to be 10.9%, compared with 12.7% in nonbraced patients. The rate of reoperation due to retear of the proximal hamstring was found to be 0.05% in braced patients and 3.1% in nonbraced patients. Patient-reported outcome measures were found to be higher at the final follow-up in braced versus nonbraced patients, and patient satisfaction was found to be 94.7% in braced studies compared with 88.9% in nonbraced studies. The rate of 12-month return to sport in athletic patients was 88.4% with bracing and 82.7% without bracing.

Conclusion: The findings of this review demonstrated lower complication and reoperation rates, higher patient-reported outcome scores, higher patient satisfaction, and a higher rate of return to sport in braced patients compared with nonbraced patients.

Keywords: accelerated rehabilitation; postoperative bracing; proximal hamstring avulsion; proximal hamstring repair.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.S. has received education payments from Fortis Surgical. C.O. has received education payments from Fortis Surgical. A.V. has received education payments from Supreme Orthopedic Systems and hospitality payments from Smith & Nephew and Arthrex. R.O. has received a grant from Arthrex and education payments from Fortis Surgical, Arthrex, Smith & Nephew, and Alon Medical Technology. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart showing the study inclusion and exclusion process.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Arner JW, Freiman H, Mauro CS, Bradley JP. Functional results and outcomes after repair of partial proximal hamstring avulsions at midterm follow-up. Am J Sports Med. 2019;47(14):3436-3443. doi:10.1177/0363546519879117 - DOI - PubMed
    1. Best R, Meister A, Meier M, Huth J, Becker U. Predictive factors influencing functional results after proximal hamstring tendon avulsion surgery: a patient-reported outcome study after 227 operations from a single center. Orthop J Sports Med. 2021;9(10):23259671211043097. doi:10.1177/23259671211043097 - DOI - PMC - PubMed
    1. Birmingham P, Muller M, Wickiewicz T, Cavanaugh J, Rodeo S, Warren R. Functional outcome after repair of proximal hamstring avulsions. J Bone Jt Surg. 2011;93(19):1819-1826. doi:10.2106/JBJS.J.01372 - DOI - PubMed
    1. Blakeney WG, Zilko SR, Edmonston SJ, Schupp NE, Annear PT. Proximal hamstring tendon avulsion surgery: evaluation of the Perth Hamstring Assessment Tool. Knee Surg Sports Traumatol Arthrosc. 2017;25(6):1936-1942. doi:10.1007/s00167-016-4214-y - DOI - PubMed
    1. Bodendorfer BM, Curley AJ, Kotler JA, et al.. Outcomes after operative and nonoperative treatment of proximal hamstring avulsions: a systematic review and meta-analysis. Am J Sports Med. 2018;46(11):2798-2808. doi:10.1177/0363546517732526 - DOI - PubMed

LinkOut - more resources