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Purpose: To compare outcome of operative and non-operative treatment of avulsion fractures of the hamstring origin, with minor (< 1.5 cm) and major (≥ 1.5 cm) displacement, and early (≤ 4 weeks) and delayed (> 4 weeks) surgery. Methods: A systematic literature search was performed using PubMed, Cochrane, Embase, CINAHL and SPORTDiscus. A quality assessment was performed using the Physiotherapy Evidence Database (PEDro) scale. Results: Eight studies with 90 patients (mean age: 16 years) were included. All studies had low methodological quality (PEDro score ≤ 5). Operative treatment yielded a return to preinjury activity rate (RTPA) of 87% (95% CI: 68–95), return to sports (RTS) rate of 100% (95% CI: 82–100), Harris hip score (HHS) of 99 (range 96–100) and a University of California Los Angeles activity scale (UCLA) score of 100%. Non-operative treatment yielded a RTPA rate of 100% (95% CI:68–100), RTS rate of 86% (95% CI: 69–94), HHS score of 99 (range 96–100), and non-union rate of 18% (95% CI: 9–34). All patients with minor displacement were treated non-operatively (RTPA: 100% [95% CI: 21–100], RTS: 100% [95% CI: 51–100]). For major displacement, operative treatment led to RTPA and RTS rates of 86% (95% CI: 65–95) and 100% (95% CI: 84–100), and 0% (0/1, 95% CI: 0–79) and 100% (95% CI: 51–100) for non-operative treatment. Early surgery yielded RTPA and RTS rates of 100% (95% CI: 34–100 & 57–100) compared to 100 (95% CI: 72–100) and 90% (95% CI: 60–98) for delayed repair. Conclusion: All included studies have high risk of bias. There is only low level of evidence with a limited number of included patients to compare outcome of operative and non-operative treatment. Overall outcome was satisfactory. There is a treatment selection phenomenon based on displacement, with acceptable outcome in both groups. There is insufficient data to draw conclusions regarding timing of surgery. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Introduction: The authors reviewed the current English literature regarding apophyseal injuries affecting young athletes, to highlight the frequency and characteristics of these injuries, to clarify risk factors and specific prevention measures, and to identify future research objectives. Sources of data: The authors performed a comprehensive search of the medical literature, using the Medline database, including all English articles. Various combinations of the Keywords 'injury', 'sports', 'athletic injuries', 'avulsion fractures', 'physeal', 'physis', 'apophysis', 'apophysitis', 'growth plate' were used. Areas of agreement: Growth benefits from a moderate physical activity. Areas of controversy: Growth deficit may occur in young athletes involved in intensive practice of sport following apophysitis. Growing points: Apophyseal injuries occurring during sport are less common than overall rate of injuries affecting the adolescent population. Growth disturbance occurs only rarely after an apophyseal injury. Areas timely for developing research: Further studies should consider analytical as well as descriptive components of apophyseal injuries, to allow the identification of new possible risk factors and preventive measures and to help early detection and proper treatment as well. [ABSTRACT FROM AUTHOR]