Early Versus Delayed Repair of Proximal Hamstring Tendon Ruptures: A Systematic Review and Meta-analysis

Background: Early recognition and repair of proximal hamstring tendon ruptures is critical, as delays can complicate surgical repair. However, the influence of surgical timing on patient outcomes remains unclear, with previous studies reporting variable results. Purpose: To evaluate the effect of early versus delayed repair on clinical outcomes after primary proximal hamstring tendon repair. Study Design: Meta-analysis. Methods: A search was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in the PubMed, Embase, and Scopus databases. Studies were included if they (1) reported outcomes of primary proximal hamstring tendon repair, (2) had ≥12 months of follow-up, (3) included patients ≥18 years, and (4) compared early versus delayed treatment. Studies were excluded if they examined outcomes of proximal hamstring tendon repair/reconstruction using an allograft. Early repair was defined as surgery within 4 to 6 weeks of injury. Risk ratios (RRs) were calculated using a random-effects model, with significance set at P < .05. Results: Twelve studies were included, encompassing 992 early and 728 delayed repairs. The mean patient age ranged from 29.7 to 53.8 years in the early group and from 29.2 to 51.8 years in the delayed group. The mean follow-up ranged from 24 to 58.8 months. Nine studies reported patient-reported outcomes (PROs) at the latest follow-up; 3 demonstrated ≥1 significantly higher PRO scores in the early repair group. Return-to-sport/activity was reported in 5 studies, but was heterogeneous: 1 study reported a significantly higher rate of sports cessation after delayed repair, whereas others showed no difference in return-to-sport metrics. Early repair was associated with a significantly reduced risk of postoperative sciatica (RR, 0.26; P = .009) and retear (RR, 0.51; P = .03). Risk of peri-incisional numbness (RR, 0.48; P = .37), infection (RR, 0.51; P = .43), and revision (RR, 0.63; P = .36) were not significantly different between early and delayed repair groups. Conclusion: Patients undergoing proximal hamstring tendon repair within 4 to 6 weeks of injury can expect mostly similar PROs and a significantly lower risk of retear and sciatica compared with patients undergoing repair after 4 to 6 weeks of injury.