Hamstrings Tear and Repair
How do the hamstrings work?
The hamstrings are comprised of three separate
muscles (semitendinosus, semimembranosus, and
biceps femoris) that run along the back of the hip
and knee joints. Collectively they function to
extend the hip and flex the knee during activities
such as running and sprinting. They originate on
a part of the pelvis called the ischial tuberosity,
a prominence that can be felt as the bony part of
the buttock when you sit down on a hard surface.
How are hamstring injuries diagnosed?
Hamstring injuries or tears are diagnosed by combining clinical symptoms (pain, weakness, deformity) with MRI findings indicative of tendon degeneration, partial thickness tearing, or complete tearing.
How are hamstring injuries treated?
The most common hamstring injury is a muscle strain due to excessive exertion or forceful contraction without proper conditioning (sprinting, hurdling, water skiing). In severe cases, partial or complete muscle tears can occur resulting in severe weakness and bruising. In general, hamstring strains take 4 – 6 weeks for full recovery while partial or complete muscle tears may take 3 – 6 months. The majority of strains can be treated without surgery using rest, ice, physical therapy, and platelet-rich-plasma (PRP) injections when indicated. Proper stretching and conditioning is the best method of preventing future injuries.
Hamstring tendon injuries are different from muscle injuries, and are divided into two types: acute and chronic.
Acute Hamstring Tendon Injury
Acute tendon tears occur due to forceful contraction while bracing to prevent a fall or injury. Most tendon tears are partial thickness, incompletely involving the width of the tendon, and do have the potential to heal without surgery. Occasionally the healing process needs to be supplemented with a series of PRP injections. Complete tears involving all three tendons tend to retract (pull away from the bone) and have a lower likelihood of successful healing, typically necessitating surgical hamstring tendon repair.
Chronic Hamstring Tendinosis
Tendinosis refers to an age related degeneration of tendon quality that renders the tissue more susceptible to injury with every day activities. Unlike the case for acute tears, chronic tendinosis can develop without a discrete injury and typically affects patients > 50 years of age. Progressive delamination of the fibers within the tendon can lead to partial thickness tearing. The body’s natural healing response is often inadequate and results in chronic inflammation and painful scarring. In the absence of a frank tear, PRP injections are effective at stimulating a healing response and can significantly reduce pain and improve function. If injections fail to provide adequate improvement or there is a frank tear, surgical hamstring tendon repair is the most reliable means of achieving successful healing and return to function.
How is hamstring tendon repair performed?
Hamstring tendon repair is a procedure designed to treat painful tendinosis and tearing of the hamstring tendons. The outpatient procedure is performed under general anesthesia and typically takes 1 – 2 hours. A small (2 – 3 inch), cosmetic incision is made in the buttock crease and the area of tearing/tendinosis is identified and debrided. Sutures are placed through the tendons and bone anchors are utilized to repair the tendon back to the bone. Given that the hamstring tendons span both the hip and the knee, a post-operative knee brace is applied to keep the knee flexed and take tension off of the repair.
What is the typical timeframe for recovery from hamstring tendon repair?
It is important to realize that the speed of recovery depends largely on the extent and type of tearing/tendinosis along with other patient related factors. Partial thickness tears that have not completely separated from the bone or complete tears that are identified early (acute) tend to recover fastest. Chronic tears (present for > 6 months) that have completely separated from the bone (retracted) tend to form scar tissue and adhesions, which complicate surgical repair and prolong recovery. Generally speaking, though, the majority of patients can expect to:
- Go home on the day of surgery
- Resume normal daily household activities within 1 – 2 days
- Take prescription pain medication for 3 – 5 days
- Return to a desk-job with intermittent walking at 7 – 10 days
- Drive a car at 3 weeks after LEFT sided surgery or 4 – 6 weeks after RIGHT sided surgery (chronic/retracted tears may take longer)
- Walk unassisted and without a limp by 4 – 6 weeks (acute/partial thickness) or 3 months (chronic/retracted)
- Start running at 8 – 10 weeks (acute/partial thickness) or 3 – 4 months (chronic/retracted)
- Return to unrestricted sports participation or a labor-intensive occupation at 2 – 3 months (acute/partial thickness) or 3 – 6 months (chronic/retracted)
Will I need to do physical therapy following hamstring tendon repair?
Absolutely. Physical therapy is critical to ensure that you get the best outcome from your surgery. With the guidance of your therapist, you will progressively advance through the various stages of your rehabilitation, as outlined in our post-operative protocol. Your therapist will have some flexibility to safely modify your progression in order to meet your specific goals and expectations.
Will I need to wear a brace after hamstring tendon repair?
Yes, given that the hamstring tendons span both the hip and the knee, a post-operative knee brace is applied to keep the knee flexed and take tension off of the repair. The brace will initially be locked at a high degree of flexion (40°– 60° depending on the extent of retraction/scarring) and will gradually be extended over time. Patients with acute/partial thickness tears with good tendon quality and a robust repair may be allowed to discontinue the brace after as little as 2 – 3 weeks. Those with chronic/retracted tears having poor tendon quality and a tenuous repair often have to wear the brace for a full 6 weeks, and sometimes longer depending on the degree of scarring and retraction.
How successful is hamstring tendon repair?
The vast majority of scientific studies have produced good to excellent outcomes in 80 – 95% of appropriately selected patients undergoing hamstring tendon repair. The reproducibility of these results is dependent on many patient and injury related factors. Dr. Mei-Dan will help you understand your unique condition and what you stand to gain with surgery, so that you can define realistic goals and expectations. At CU Sports MEd Hip Clinic, your satisfaction is our priority.
Am I a good candidate for hamstring tendon repair?
Whether hamstring tendon repair is a worthwhile option for you depends on a number of factors, including:
• Your age
• The extent of tearing or tendinosis
• The extent of scarring or retraction
In general, the outcomes of hamstring tendon repair are best for acute tears or partial thickness tears with good tissue quality. Dr. Mei-Dan will guide you through the various considerations in helping you decide whether surgery is right for you.
Choosing the treatment option that is right for you involves careful consideration of your diagnosis, duration and severity of symptoms, desired level of activity, as well as social and financial elements. You are not alone in this process.
As you research your condition, please write down all of your questions and bring them with you to your next appointment. Dr. Mei-Dan and his team will take time to address all of your concerns, until you are completely satisfied with your treatment plan.