Proximal Hamstring Repairs Show Similar Load to Failure to Intact Hamstring Tendons: A Systematic Review and Meta-analysis of Biomechanical Investigations

Purpose

To review cadaveric studies evaluating the maximum load to failure after proximal hamstring repair with various numbers and sizes of anchors.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used when conducting this systematic review. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus were queried in July 2024. Articles were included if they reported on the load to failure or maximum load in human cadavers undergoing proximal hamstring repair. Maximum load to failure was pooled among studies evaluating repairs compared with intact native hamstring tendons. The Biomechanics Objective Basic Science Quality Assessment Tool (BOBQAT) was used to score all articles.

Results

Six studies reporting on 97 human cadaveric hemipelves undergoing open repair for proximal hamstring tears were included. The mean ages of cadavers ranged from 45.4 to 63.0 years. The mean maximum load to failure ranged from 183.3 to 1,164 N. Repairs showed no statistically significant difference in maximum load to failure when compared with native proximal hamstrings, with an effect size of –0.31 (95% confidence interval, –1.05 to 0.42; P = .40).

Conclusions

Proximal hamstring repair shows a wide range of maximum loads to failure, with repaired hamstrings achieving loads to failure comparable to those of intact tendons. Repairs incorporating 3 or more anchors may improve load to failure.

Clinical Relevance

Investigating the strength of proximal hamstring repair techniques can help surgeons identify which techniques may provide the strongest repair for patients. Proximal hamstring repairs show similar levels of load to failure compared with native hamstring tendons.