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Hamstring Tendon Repair

When is surgery indicated for a proximal hamstring tendon tear?

  1. Proximal hamstring tendon ruptures can occur when the tendon is torn away from the bone after an acute injury, such as a fall or sporting injury. Sometimes, a hamstring tendon can also pull off a small bone, which is called a hamstring avulsion injury. These types of injuries typically occur in young, skeletally immature athletes. Surgery done early is necessary to prevent muscle retraction and to achieve optimal outcomes.
  2. Longstanding or chronic injuries that do not respond to nonsurgical treatment and result in continued weakness and pain may require surgery to restore the individual’s ability to participate in sports and daily activities.

Proximal hamstring tear repair is an outpatient surgery performed under general anesthesia.

  • An incision is made over the back of the thigh, at the bottom of the buttocks, to expose the torn hamstring.
  • The proximal hamstring tendon is reattached to the bone, and suture anchors are placed into the pelvis bone called the ischium. This restores the normal anatomy of the hamstring tendon.
  • Care is taken to protect the sciatic nerve, which is located on the outside of the hamstring tendon, throughout the surgery.

Recovery from hamstring tear repair surgery is a long process that can take six months to 1 year and involves rest and protection, physical therapy, and a gradual return to normal activities. The rehabilitation process is critical to regaining strength, flexibility, and function. Initial recovery typically focuses on protection and reducing swelling and pain. At the same time, later stages involve exercises to improve the range of motion, strengthen the muscles, and return to sports and/or impact activities.

  • Early recovery: Crutches or a walker are used to limit weight bearing on the affected leg for 6 weeks after surgery. Post-operative bracing is typically recommended. Our study (Wong et al., cited below) demonstrated good outcomes with our unique bracing protocol, which may be more comfortable for the patient while protecting the repair. The brace protects the proximal hamstring tendon repair and limits the range of motion to safe parameters during the early stages of healing.
  • Progressive rehabilitation: Structured physical therapy for a gradual introduction to exercises to restore movement and strength. Depending on their individual goals, patients may attend physical therapy for several months after surgery. Rehabilitation is crucial for a successful return to normal activities or sports.
  • Return to activities: Outcomes are generally good following this surgery, especially in younger, active individuals. Returning to high-level impact activities or sports takes around six months or more.

When you injured your proximal hamstring tendon or have hamstring pain that interferes with your daily life and the activities you enjoy, contact the UCSF Women’s Sports Medicine Center to schedule a consultation. The UCSF Women’s Sports Medicine Center supports female athletes of all ages and abilities, from the recreational to the elite athlete, with a team of sports medicine and orthopedic specialists. We offer comprehensive care to help our patients recover well, learn how to avoid re-injury injury, and achieve the level of physical activity and performance they desire. Contact us to schedule a consultation to learn more. We have offices in San Francisco, Berkeley, and Redwood City.

References

  • https://orthoinfo.aaos.org/en/diseases–conditions/hamstring-muscle-injuries/
  • Belk JW, Kraeutler MJ, Mei-Dan O, Houck DA, McCarty EC, Mulcahey MK. Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review. Orthop J Sports Med. 2019 Jun 24;7(6):2325967119853218. doi: 10.1177/2325967119853218. PMID: 31259189; PMCID: PMC6591667.
  • Aujla RS, Cecchi S, Koh E, D’Alessandro P, Annear P. Surgical treatment of high-grade acute intramuscular hamstring tendon injuries in athletes leads to predictable return to sports and no reinjuries. Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4601-4606. doi: 10.1007/s00167-023-07477-x. Epub 2023 Jul 10. PMID: 37428237.
  • Kayani B, Ayuob A, Begum F, Khan N, Haddad FS. Surgical Management of Chronic Incomplete Proximal Hamstring Avulsion Injuries. Am J Sports Med. 2020 Apr;48(5):1160-1167. doi: 10.1177/0363546520908819. Epub 2020 Mar 16. PMID: 32178527.
  • Wong SE, Julian KR, Carpio JG, Zhang AL. Proximal Hamstring Repair With All-Suture Anchors and an Accelerated Rehabilitation and Bracing Protocol Demonstrates Good Outcomes at 1-Year Follow-Up. Arthrosc Sports Med Rehabil. 2024;6(2):100891. Published 2024 Feb 10. doi:10.1016/j.asmr.2024.100891
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