Summary

Studies included in this review indicate that DVT can occur in patients with both partial and complete avulsions, as well as those with chronic and acute injuries, and though our study is able to comment to some degree on the limited consensus regarding prophylaxis and treatment of DVT in this setting, it highlights the limited data on nature and management of this particular complication.

Abstract

Background

Deep venous thrombosis (DVT) is a life-threatening complication, which can occur following proximal hamstring tendon repair surgery. While previous studies have discussed DVT in the broader context of all postoperative complications of proximal hamstring repair, this is the first systematic review to focus specifically on DVT. There is a paucity of information in the literature on the rate of occurrence or the variety of factors that influence DVT formation in the postoperative period, including patient demographics, the nature and timing of their injury, or their postoperative rehabilitation course. The purpose of this study was to assess the relative risk of DVT as well as characterize the factors related to the development and treatment of DVTs following proximal hamstring repair.

Methods

A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and EMBASE were searched from database origin to April 2019 by 2 independent reviewers. Search terms included “hamstring,” “tear,” “avulsion,” “rupture,” and “proximal”. Studies were included if they discussed proximal hamstring repair, postoperative outcomes for at least 6 months, patient demographics, number of tendons injured, and specified if the injury was acute or chronic. Studies were excluded if they were case reports, review articles, anatomic reviews, radiologic assessments, surgical technique reviews, cadaveric studies, non-English language, and if there was a lack of documented surgical complications.

Results

Of 452 initial results, 274 unique records were found, of which 268 were excluded after review, resulting in 6 studies (290 patients, 294 proximal hamstring repairs) that were found to meet the inclusion criteria, as demonstrated in Figure 1. 132 (44.9%) hamstring injuries were categorized as acute and 162 (55.1%) were classified as chronic. Overall, 6 cases of DVT were identified in the postoperative period, which made up 2.1% (6/290) of the study population or 2.04% (6/294) of the surgical cases. 2 (33.3%) of the DVTs occurred in patients undergoing repair for chronic proximal hamstring tendon ruptures. At least 3 (50%) of the DVTs occurred in patients with a complete proximal hamstring tendon avulsion. All 6 (100%) DVTs occurred following an open surgical approach.

Conclusions

There is limited data on the incidence of DVT in the setting of proximal hamstring repair. The 6 studies included in this review indicate that DVT can occur in patients with both partial and complete avulsions, as well as those with chronic and acute injuries. Therefore, orthopaedic surgeons should understand that all patients undergoing repair of proximal hamstring avulsion injuries are at risk of developing a DVT. While our study is able to comment to some degree on the limited consensus regarding prophylaxis and treatment of DVT in this setting, it also highlights the limited data on the nature and management of this particular complication. Additional studies are needed to determine if there is an association between DVT and hamstring tendon injury type (acute vs chronic), rehabilitation protocol, prophylaxis use, and surgical technique.