Return to play is reliable, but market value declines after proximal hamstring repair in elite soccer players

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Abstract
Purpose: The purpose of this study was to quantify return‐to‐play (RTP) time, post‐operative performance and market‐value trends after proximal hamstring repair in top‐tier European league soccer players. It was hypothesized that surgery would achieve a high RTP rate but be accompanied by reductions in player performance and valuation. Methods: Male first‐team players from the five major European leagues who underwent surgical repair of proximal hamstring ruptures between 2019 and 2022 were identified collaboratively with the InjuryMechanisms platform. Publicly available data (Transfermarkt) was accessed to extract demographics and season‐by‐season metrics for two seasons before and two seasons after injury. Outcomes were RTP time, matches missed, percentage of minutes played per season (MPS), goals, assists and market value. Non‐parametric Friedman test with Dunn–Bonferroni post hoc test assessed longitudinal changes. Results: Twenty players (mean age, 25.3 ± 4.4 years) met the inclusion criteria. All returned to professional competition without reoperation. Mean RTP was 160 ± 76 days, with 21.5 ± 11.5 matches missed. Goals and assists were unchanged across seasons ( p > 0.05). MPS showed a non‐significant reduction from 50.2 ± 15.5% pre‐injury to 34.5 ± 16.3% in the first post‐operative season and partially recovered to 43.0 ± 23.9% in the second season. Mean market value significantly declined from €22.1 ± 36.7 and €20.4 ± 34.4 million in the two pre‐injury seasons to €15.2 ± 27.4 million two seasons post ( p < 0.001). Conclusion: Surgical repair of proximal hamstring rupture allowed reliable return to competition in elite soccer players, with preserved performance. However, players experienced a transient, non‐significant reduction in competitive involvement during the first post‐operative season and market value significantly declined despite favourable performance outcomes. Level of Evidence: Level IV.

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