Clin Sports Med. 2021 Apr;40(2):339-361. doi: 10.1016/j.csm.2021.01.003. Epub 2021 Feb 10.
Proximal hamstring injuries can present as chronic tendinosis, acute strain, partial tendinous avulsions, or complete 3-tendon rupture. Nonoperative management for chronic insertional tendinosis and low-grade tears includes activity modification, anti-inflammatories, and physical therapy. Platelet-rich plasma injections, corticosteroid injections, dry needling, and shock wave therapy are newer therapies that also may provide benefit. Surgical indications include complete, proximal avulsions; partial avulsions with least 2 tendons injured with more than 2 cm of retraction in young, active patients; and partial avulsion injuries or chronic tendinosis that have failed nonoperative management. Surgical management entails open primary repair, endoscopic primary repair, or augmentation/reconstruction.