Proximal Hamstring Repair

A proximal hamstring repair reattaches the hamstring tendons (semimembranosus, semitendinosus and biceps femoris) to the ischial tuberosity after they have been pulled off the bone. The injury usually happens with a forceful stretch while the hamstring is contracting, with the hip bent and the knee straight, and is common in athletes whose sport involves sudden speeding up and slowing down; the patient often feels a pop, then has bruising and pain in the back of the upper thigh. In children the same force can pull off a piece of bone (an avulsion fracture). Surgery is recommended for complete tears of all three tendons, for tears of two tendons pulled back more than 2 cm in young active patients, for bony avulsions displaced 2 cm or more, and for partial tears or tendinosis that do not improve with months of conservative care. Early repair is easier: after about four to six weeks, scar forms around the tendon and the sciatic nerve, the tendon is harder to bring down, and the risk of nerve injury rises. The open repair through a gluteal-crease incision is described here; it gives direct sight of the tendon and nerve and easy suture passing. An endoscopic repair through small portals with a 30-degree arthroscope is also done for less retracted tears, and some surgeons use a double-row repair with a knotless anchor. After surgery the knee is kept bent in a hinged brace (or the hip kept extended in an orthosis) for about six weeks, with return to sport usually at four months or later. Complications include wound problems and infection, numbness near the incision, sciatic or pudendal nerve irritation or injury, and re-rupture.