Successful rapid return to performance following non-operative treatment of proximal hamstring tendon avulsion in elite athletes

Objectives Proximal hamstring tendon avulsion injuries are severe and potentially career-threatening for elite athletes. Until now, no data have been published on the non-operative treatment of this injury in elite athletes. Therefore, the objective of this case series was to describe return to performance in elite athletes after non-operative treatment of full-thickness proximal hamstring tendon avulsion injuries as well as provide detailed description of the rehabilitation process and provide a mechanobiological hypothesis on processes leading to successful outcomes. Methods In this retrospective case series, we included three elite athletes with four MRI-confirmed acute proximal hamstring tendon avulsions of the conjoint tendon and/or the semimembranosus tendon who opted for non-operative treatment following shared decision-making, consisting of an individualised rehabilitation programme. The primary outcome was time to return to performance (in weeks). Secondary outcomes were time to and rate of return to competition, rate of return to performance and re-injury rate. Results Four proximal hamstring tendon avulsions in three elite athletes were included. All elite athletes returned to performance within 8-33 weeks, which for three out of four cases was at Olympic (gold medal) level. Conclusion This (pilot) case series indicates that non-operative treatment for full-thickness proximal hamstring avulsion injury can result in return to performance in elite athletes. Non-operative treatment may therefore be a viable treatment option in selected (elite) athletes.