Most hamstring injuries occur while running or sprinting, and the strain or tear occurs in the muscle. This type of injury does not require surgery, but therapy is vital to ensuring maximal recovery. Occasionally, the hamstring tendon can tear off its bony proximal (near) attachment to the pelvis at the ischium or “sit bone”. This type of tear occurs frequently in patients over 50 years of age, during activities like water skiing and tennis or with a fall. The tear is caused when the leg is straight and the trunk hyperflexes (forward), causing the tendon to rupture off of the bone. A sharp pain, pop and extensive bruising in the back of the thigh is common. This type of tear generally requires surgery, as the tendon retracts (pulls away from the bone) and cannot heal properly on its own, resulting in pain, weakness, and poor leg control. Occasionally, the hamstring tendon can be partially torn, from chronic overuse. Partial tears may improve with non-surgical treatment, including anti-inflammatory medications, therapy, activity modification, and injections (steroid or PRP). If symptoms fail to improve, surgery is recommended.
All partial and many complete proximal hamstring tendon tears can be repaired using a minimally-invasive endoscopic approach. Small incisions are made around the ischium (sit bone), and a small camera is inserted to visualize the torn tendon and bony attachment site. Using specialized tools and suture anchors placed into the bone, sutures are passed through the hamstring tendon tissue. The sutures are then tied down, securing the tendon to its native bony attachment. Occasionally, if the tear is chronic, scarred down, or significantly retracted an open approach may be needed.
A proximal hamstring tendon repair is an outpatient surgery, allowing patients to go home the same day. Most patients require a brace after surgery for up to six weeks. The brace is needed to prevent the leg from certain motions and to protect the repair. Weight-bearing (the amount of weight one is able to put on the operative leg) is modified based on the severity of the tendon tear, and crutches will be provided and required after surgery. Therapy will begin immediately to facilitate decreased swelling and pain, muscle activation and motion, and eventually improve strength to maximize function after surgery.