Proximal Hamstring Repair

The hamstring muscles are three muscles at the back of the thigh that are commonly injured during sports that involve running, jumping and sudden changes in speed. Injury usually occurs at the proximal tendinous origin of the muscles which attach to the ischium, a pelvic bone. The risk of injury increases with age, prior injury, lack of flexibility and being overweight.

Strains of the hamstring are usually treated by nonoperative means such as compression and limiting weight bearing, Complete rupture of the hamstrings requires surgical correction. Hamstring injuries are usually acute and associated with sudden pain, muscle spasm, and difficulty walking. A pop may occasionally be felt or heard. The back of the thigh is usually bruised and tender and swelling may be present.

Your doctor will order imaging studies to view the area of injury. In case of a complete rupture, the tendon may be pulled away or retracted from the site surgically. If there is minimal retraction (<2 cm) or if fewer tendons are involved then a nonsurgical approach may be appropriate. Surgery is recommended when there is greater retraction and return to sports and strenuous activity is desired.

If treatment is delayed, your symptoms usually intensify with more muscle atrophy and weakness. Acute repair of complete ruptures has better outcomes.

Surgery is performed under general anesthesia and you will lie face down for the procedure. An incision is made in the buttock fold and the tissues are separated. Any blood collection or scar tissue is removed. The sciatic nerve is identified and protected. If a tendon stump is present on the ischium, it is removed. The ruptured tendon is identified and reattached to the ischial tuberosity with sutures. In case of chronic injuries, there may be significant scar tissue involving the sciatic nerve and muscle making reattachment difficult. Sciatic neurolysis and the use of an allograft may be necessary. Once repair is complete, bleeding is carefully controlled to prevent hematoma and nerve compression. The tissues are closed in layers and a sterile dressing is placed.

Following surgery, you will be on crutches with limited (toe touch) weight bearing. You will have to avoid movements such as bending your hip, extending your knee and other activities that strain the hamstrings. Braces are worn for 6 weeks to help you limit range of motion. You will then gradually increase weight bearing and range of motion. Hamstring exercises as well as core and hip stabilizing exercises are introduced and you can safely return to sports in about 6 months.