Increasing incidence of surgically treated hamstring injuries: a nationwide registry study in Sweden between 2001 and 2020


  • Sofia Laszlo Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
  • Kenneth B Jonsson Department of Surgical Sciences, Uppsala University, Uppsala, Sweden



Hamstring, Hip, Tendon


Background and purpose: Data on incidence and on trends in treatment of hamstring injuries, including proximal hamstring tendon avulsions (PHA), is limited. We aimed to investigate the incidence, trends in operative treatment, age, and sex distribution of hamstring injuries in Sweden between 2001 and 2020.
Patients and methods: We obtained data recorded in the National Patient Register between 2001 and 2020 on patients between 18 and 90 years of age, with the ICD-10 code S76.3, to calculate the incidence of patients treated operatively for hamstring injuries in Sweden. Patients with the NOMESCO classification NFL49 were considered as having been treated operatively. Data on quadriceps and Achilles tendon injuries were obtained for comparison. To calculate incidences, adult population data for every year were obtained from the Statistics Sweden website.
Results: The incidence of patients diagnosed with hamstring injuries increased from 2.2 to 7.3 per 100,000 person-years. There was a rising trend of surgical treatment per diagnosed case from 3.0% to 14.2%. Patients diagnosed in units with the highest experience of surgical treatment of hamstring injuries tended to be operated on more often (22.2%) than patients diagnosed in units with limited experience (5.1%), although the fraction of operated patients was increasing in both groups.
Conclusion: Between 2001 and 2020 there was an increase in the proportion of operatively treated hamstring injuries.


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Opar D A, Williams M D, Shield A J. Hamstring strain injuries: factors that lead to injury and re-injury. Sports Med 2012; 42: 209-26. doi: 10.2165/11594800-000000000-00000. DOI:

Ali K, Leland J M. Hamstring strains and tears in the athlete. Clin Sports Med 2012; 31: 263-72. doi: 10.1016/j.csm.2011.11.001. DOI:

Barnett A J, Negus J J, Barton T, Wood D G. Reattachment of the proximal hamstring origin: outcome in patients with partial and complete tears. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2130-5. doi: 10.1007/s00167-013-2817-0. DOI:

Irger M, Willinger L, Lacheta L, Pogorzelski J, Imhoff A B, Feucht M J. Proximal hamstring tendon avulsion injuries occur predominately in middle-aged patients with distinct gender differences: epidemiologic analysis of 263 surgically treated cases. Knee Surg Sports Traumatol Arthrosc 2020; 28: 1221-9. doi: 10.1007/s00167-019-05717-7. DOI:

Pihl E, Skoldenberg O, Nasell H, Jonhagen S, Kelly Pettersson P, Hedbeck C J. Patient-reported outcomes after surgical and non-surgical treatment of proximal hamstring avulsions in middle-aged patients. BMJ Open Sport Exerc Med 2019; 5: e000511. doi: 10.1136/bmjsem-2019-000511. DOI:

Kuske B, Hamilton D F, Pattle S B, Simpson A H. Patterns of hamstring muscle tears in the general population: a systematic review. PLoS One 2016; 11: e0152855. doi: 10.1371/journal.pone.0152855. DOI:

Ropiak C R, Bosco J A. Hamstring injuries. Bull NYU Hosp Jt Dis 2012; 70: 41-8. PMID: 22894694.

Pasic N, Giffin J R, Degen R M. Practice patterns for the treatment of acute proximal hamstring ruptures. Phys Sportsmed 2020; 48: 116-22. doi: 10.1080/00913847.2019.1645576. DOI:

Bodendorfer B M, Curley A J, Kotler J A, Ryan J M, Jejurikar N S, Kumar A, et al. Outcomes after operative and nonoperative treatment of proximal hamstring avulsions: a systematic review and meta-analysis. Am J Sports Med 2018; 46: 2798-808. doi: 10.1177/0363546517732526. DOI:

Laszlo S, Nilsson M, Pihl E, Mattila V M, Schilcher J, Skoldenberg O, et al. Proximal hamstring tendon avulsions: a survey of orthopaedic surgeons’ current practices in the Nordic countries. Sports Med Open 2022; 8: 49. doi: 10.1186/s40798-022-00439-6. DOI:

Kannus P, Natri A. Etiology and pathophysiology of tendon ruptures in sports. Scand J Med Sci Sports 1997; 7: 107-12. doi: 10.1111/j.1600-0838.1997.tb00126.x. DOI:

King D, Yakubek G, Chughtai M, Khlopas A, Saluan P, Mont M A, et al. Quadriceps tendinopathy: a review—part 1: epidemiology and diagnosis. Ann Transl Med 2019; 7: 71. doi: 10.21037/atm.2019.01.58. DOI:

Sanchez Romero E A, Pollet J, Martin Perez S, Alonso Perez J L, Munoz Fernandez A C, Pedersini P, et al. Lower limb tendinopathy tissue changes assessed through ultrasound: a narrative review. Medicina (Kaunas) 2020; 56. doi: 10.3390/medicina56080378. DOI:

Cerciello S, Visona E, Corona K, Ribeiro Filho P R, Carbone S. The treatment of distal biceps ruptures: an overview. Joints 2018; 6: 228-31. doi: 10.1055/s-0039-1697615. DOI:

Ludvigsson J F, Andersson E, Ekbom A, Feychting M, Kim J L, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health 2011; 11: 450. doi: 10.1186/1471-2458-11-450. DOI: [Internet]. Population by age and sex. Year 1860 - 2022; c2022 [cited 2022 Mar 28]. Available from:

Ahmad C S, Redler L H, Ciccotti M G, Maffulli N, Longo U G, Bradley J. Evaluation and management of hamstring injuries. Am J Sports Med 2013; 41: 2933-47. doi: 10.1177/0363546513487063. DOI:

Arner J W, McClincy M P, Bradley J P. Hamstring injuries in athletes: evidence-based treatment. J Am Acad Orthop Surg 2019; 27: 868-77. doi: 10.5435/JAAOS-D-18-00741. DOI:

van der Made A D, Peters R W, Verheul C, Smithuis F F, Reurink G, Moen M H, et al. Proximal hamstring tendon avulsions: comparable clinical outcomes of operative and non-operative treatment at 1-year follow-up using a shared decision-making model. Br J Sports Med 2022; 56: 340-8. doi: 10.1136/bjsports-2021-104588. DOI:

Smith-Bindman R, Kwan M L, Marlow E C, Theis M K, Bolch W, Cheng S Y, et al. Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000–2016. JAMA 2019; 322: 843-56. doi: 10.1001/jama.2019.11456. DOI:

Mattila V M, Huttunen T T, Haapasalo H, Sillanpaa P, Malmivaara A, Pihlajamaki H. Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study. Br J Sports Med 2015; 49: 1084-6. doi: 10.1136/bjsports-2013-092756. DOI:

Marshall P W, Siegler J C. Lower hamstring extensibility in men compared to women is explained by differences in stretch tolerance. BMC Musculoskelet Disord 2014; 15: 223. doi: 10.1186/1471-2474-15-223. DOI:

Pihl E, Kristoffersen M H, Rosenlund A M, Laszlo S, Berglof M, Ribom E, et al. The proximal hamstring avulsion clinical trial (PHACT): a randomised controlled non-inferiority trial of operative versus non-operative treatment of proximal hamstrings avulsions: study protocol. BMJ Open 2019; 9: e031607. doi: 10.1136/bmjopen-2019-031607. DOI:

Forss A, Myrelid P, Olen O, Everhov A H, Nordenvall C, Halfvarson J, et al. Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register. BMC Med Inform Decis Mak 2019; 19: 217. doi: 10.1186/s12911-019-0948-z. DOI:



How to Cite

Laszlo, S., & Jonsson, K. B. (2023). Increasing incidence of surgically treated hamstring injuries: a nationwide registry study in Sweden between 2001 and 2020. Acta Orthopaedica, 94, 336–341.