Patients Undergoing Proximal Hamstring Repair Have High Rates of Return to Work and Favorable Outcomes: A Systematic Review

Purpose To evaluate return‐to‐work (RTW) rates and functional outcomes after surgical repair of proximal hamstring tendon avulsion injuries. Methods This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and was registered with the International Prospective Register of Systematic Reviews. PubMed, Cochrane Central Register of Controlled Trials, and Scopus were searched in April 2025 for studies reporting RTW outcomes after surgical repair of proximal hamstring avulsions. Eligible studies involved human subjects undergoing open or endoscopic repair and reporting RTW rates or patient counts. No minimum follow‐up duration was required. Two reviewers independently screened and extracted data, with discrepancies resolved by a third. Study quality was assessed using the Methodological Index for Non‐Randomized Studies criteria. Results Six studies (229 patients) met inclusion criteria. Four studies reported an overall RTW rate ranging from 89% to 100%, whereas 2 studies stratified outcomes by Workers’ Compensation (WC) status, showing lower RTW rates among WC patients (70.0%‐86.3%) compared with non‐WC patients (92.5%‐94.1%). Return‐to‐sport rates, when reported, ranged from 58% to 100%. Study‐level RTW and return‐to‐sport outcomes were summarized descriptively without pooled estimates because of heterogeneity in study design, surgical approach, injury chronicity, WC status, and outcome definitions. Complication rates were low overall, with retear or reoperation occurring in 0% to 5.8% of cases. Clinically relevant patient improvement thresholds were only reported in 1 study. Conclusions In this study, most patients undergoing surgical repair for proximal hamstring avulsion injuries return to work with favorable functional outcomes and low complication rates. Level of Evidence Level IV, systematic review of Level III and IV studies.