Proximal hamstring repair

Many proximal hamstring injuries — strains and many partial tears — are treated without surgery. Repair is generally considered for selected injuries, most often a complete avulsion where the tendons have pulled off the sit bone and retracted, and in some other individualized situations.

The decision is individualized and weighs the type of injury, the degree of retraction, whether it is acute or chronic, your symptoms and function, and your activity and goals — a fuller discussion is on the proximal hamstring injuries condition page.

In a proximal hamstring repair, the surgeon reaches the back of the pelvis where the hamstring attaches, frees the retracted tendon, and reattaches it to its footprint on the ischial tuberosity — usually with anchors placed in the bone and sutures that hold the tendon against the bone while it heals. Where a fragment of bone has pulled off with the tendon, that is addressed as part of the repair.

The specifics depend on the injury and are decided by your surgeon. The aim is a secure reattachment that lets the hamstring heal in a good position so the muscle can again do its work.

The sciatic nerve runs just behind the proximal hamstring attachment. In a chronic injury, scar tissue can form around the nerve, and part of the operation may involve carefully freeing the tendon from that scar while protecting the nerve. Because of this close relationship, some numbness or altered sensation down the leg can occur after surgery, and nerve-related symptoms are something your surgeon will discuss and monitor.

New or worsening numbness, tingling, or weakness down the leg after surgery should be reported to your care team.

An acute repair addresses a recent injury, where the tendon can usually be brought back to the bone more directly. A chronic repair addresses a long-standing injury, where the tendon may be more retracted and scarred and the surrounding tissue and the sciatic nerve may need more attention; occasionally additional steps are needed to reach and reattach the tendon.

A chronic, revision, or otherwise complex repair may follow a different, often more protective plan than a straightforward acute repair. Your surgeon determines the plan that fits what was actually done.

Recovery after a proximal hamstring repair is gradual and staged. Early on, the repair is protected — this commonly includes a period of limited weight bearing, a brace that limits how much the hamstring is stretched, and avoiding active hamstring loading — to give the tendon time to heal to the bone. From there, motion and weight bearing are progressed, then hamstring and lower-limb strength are rebuilt, and finally a running and sport-specific progression is added when the criteria for it are met.

The pace is guided by healing and by how strength and control return, not by a fixed calendar. The proximal hamstring repair rehabilitation protocol below lays out the general progression; the specific restrictions and timing are set for you by your care team, and your operative note takes precedence.

Every operation has trade-offs. The possibilities below are for discussion with your surgeon and are not a complete list:

• Infection
• The tendon failing to heal fully, or re-tearing
• Sciatic-nerve irritation or numbness, and (uncommonly) nerve injury
• Persistent pain, weakness, or discomfort with sitting
• Blood clots
• Wound-healing problems
• Stiffness
• A need for further treatment or surgery

The goal of a proximal hamstring repair is a healed, reattached tendon and a hamstring that works well and comfortably for your daily life and activities. Recovery is gradual and protected, and results are individual. The right path — and whether repair is part of it — is the one matched to your specific injury and goals after a clear conversation with your surgeon.