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Risk factors of recurrent hamstring injuries: a systematic review
  1. HM de Visser,
  2. M Reijman,
  3. MP Heijboer,
  4. PK Bos
  1. Department of Orthopaedic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Pieter K. Bos, Department of Orthopaedics, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; p.k.bos{at}erasmusmc.nl

Abstract

Background Although recurrent hamstring injury is a frequent problem with a significant impact on athletes, data on factors determining the risk for a recurrent hamstring injury are scarce.

Objective To systematically review the literature and provide an overview of risk factors for re-injury of acute hamstring muscle injuries.

Study design Prospective studies on risk factors for re-injury following acute hamstring injuries were systematically reviewed. Medical databases and reference lists of the included articles were searched. Two reviewers independently selected potential studies and assessed methodological quality; one reviewer extracted the data. A best-evidence synthesis of all studied risk factors was performed.

Results Of the 131 articles identified, five prospective follow-up studies fulfilled our inclusion criteria. These studies reported a recurrence incidence of 13.9–63.3% in the same playing season up to 2 years after initial injury. Limited evidence for three risk factors and one protective factor for recurrent hamstring injury was found; patients with a recurrent hamstring injury had an initial injury with a larger volume size as measured on MRI (47.03 vs 12.42 cm3), more often had a Grade 1 initial trauma (Grade 0: 0–30.4%; Grade 1: 60.9–100%; Grade 2: 8.7%) and more often had a previous ipsilateral anterior cruciate ligament (ACL) reconstruction (66.6% vs 17.1%) independent of graft selection. Athletes in a rehabilitation programme with agility/stabilisation exercises rather than strength/stretching exercises had a lower risk for re-injury (7.7% vs 70%). No significant relationship with re-injury was found for 11 related determinants. There was conflicting evidence that a larger cross-sectional area is a risk factor for recurrent hamstring injury.

Conclusions There is limited evidence that athletes with a larger volume size of initial trauma, a Grade 1 hamstring injury and a previous ipsilateral ACL reconstruction are at increased risk for recurrent hamstring injury. Athletes seem to be at lower risk for re-injury when following agility/stabilisation exercises.

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Footnotes

  • Competing interests None.

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

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