Injuries to the hamstring muscle complex are common in athletes, accounting for between 12% and 26% of all injuries sustained during sporting activities. Acute hamstring injuries often occur during sports that involve repetitive kicking or high-speed sprinting, such as American football, soccer, rugby, and athletics. They are also common in watersports, including waterskiing and surfing. Hamstring injuries can be career-threatening in elite athletes and are associated with an estimated risk of recurrence in between 14% and 63% of patients. The variability in prognosis and treatment of the different injury patterns highlights the importance of prompt diagnosis with magnetic resonance imaging (MRI) in order to classify injuries accurately and plan the appropriate management. Low-grade hamstring injuries may be treated with nonoperative measures including pain relief, eccentric lengthening exercises, and a graduated return to sport-specific activities. Nonoperative management is associated with highly variable times for convalescence and return to a pre-injury level of sporting function. Nonoperative management of high-grade hamstring injuries is associated with poor return to baseline function, residual muscle weakness and a high-risk of recurrence. Proximal hamstring avulsion injuries, high-grade musculotendinous tears, and chronic injuries with persistent weakness or functional compromise require surgical repair to enable return to a pre-injury level of sporting function and minimize the risk of recurrent injury. This article reviews the optimal diagnostic imaging methods and common classification systems used to guide the treatment of hamstring injuries. In addition, the indications and outcomes for both nonoperative and operative treatment are analyzed to provide an evidence-based management framework for these patients. Cite this article:
The World Health Organization (WHO) launched
the first Global Patient Safety Challenge in 2005 and introduced
the ‘5 moments of hand hygiene’ in 2009 in an attempt to reduce
the burden of health care associated infections. Many NHS trusts
in England adopted this model of hand hygiene, which prompts health
care workers to clean their hands at five distinct stages of caring
for the patient. Our review analyses the scientific foundation for
the five moments of hand hygiene and explores the evidence, as referenced
by WHO, to support these recommendations. We found no strong scientific
support for this regime of hand hygiene as a means of reducing health
care associated infections. Consensus-based guidelines based on
weak scientific foundations should be assessed carefully to prevent
shifting the clinical focus from more important issues and to direct
limited resources more effectively. We recommend caution in the universal adoption of the WHO ‘5
moments of hand hygiene’ by orthopaedic surgeons and other health
care workers and emphasise the need for evidence-based principles
when adopting hospital guidelines aimed at promoting excellence
in clinical practice.
