Proximal Hamstring Repair

What is a proximal hamstring tear?

A proximal (high) hamstring tear occurs when one or more of the muscles become torn from the ischial tuberosity, the attachment site. Hamstring injuries are classified in the following grades:

• Grade 1 – Classified as a hamstring pull
• Grade 2 – A partial tear
• Grade 3 – A full, or complete tear

This injury is typically caused by muscle overload. The hamstring muscles can become strained from muscle tightness, muscle imbalance, muscle fatigue and poor conditioning, leading to a hamstring tear.

What are the symptoms of a proximal hamstring tear?

Patients and athletes most often complain of deep buttock pain. Other symptoms related to proximal hamstring tears are:

• Swelling and bruising
• Sharp, sudden pain in the back of the thigh (often causes many athletes to come to a quick halt when the injury occurs.)
• Pain when sitting
• Pain with repetitive activities
• Pain when accelerating, or pushing off to run
• Pain when bending at the hip

How is a proximal hamstring tear diagnosed?

Dr. Nwachukwu diagnoses a proximal hamstring tear by performing a physical examination and a review of symptoms. He will check for any visible bruising and swelling in the injured leg. An X-ray and MRI may also be performed to determine the extent of injury and to properly classify the injury as a Grade 1, 2 or 3.

How is a torn hamstring repaired?

Non-Surgical Treatment:

The majority of tears to the hamstring are partial thickness tears where only a portion of the muscle has been torn. In these cases, Dr. Nwachukwu prefers a conservative approach which includes rest, ice and a compression band or wrap for support of the healing muscle. Anti-inflammatory medications can alleviate hamstring pain, and physical therapy may also be recommended to restore strength and range of motion. If the patient is unable to improve with this program, Dr. Nwachukwu may use an ultrasound-guided corticosteroid or platelet rich plasma injection which has been shown to provide pain relief.

Surgical Treatment:

A surgical repair is often performed in patients who have experienced a complete tendon avulsion injury, where the tendon has completely pulled away from the bone. During this procedure, Dr. Nwachukwu will relocate the hamstring muscle and tendon back to its correct position, remove any scar tissue, and then reattach the tendon to the bone. This procedure has a high success rate of alleviating hamstring pain and restoring strength.

What is an endoscopic hamstring repair?

For small hamstring tears without significant retraction, endoscopic hamstring repair can be performed. Endoscopy means “looking inside” which is how Dr. Nwachukwu can treat some hamstring tears. A special instrument, called an endoscope, is inserted into the buttock at the location where the hamstring is torn. Small surgical instruments are also inserted through separate incisions, and are used to perform the repair using a minimally invasive approach.

What is an open proximal hamstring repair?

Open surgical repair of a torn hamstring has been the standard of care and is commonly performed for tears that involve more than one tendon, is chronic in nature, or where there is significant retraction. An open repair of a torn hamstring involves a standard incision where Dr. Nwachukwu can directly visualize the extent of the injury and retraction.

How long is the recovery after a proximal hamstring repair?

Post-operative recovery for both open and endoscopic surgery typically requires 6 weeks of restricted weight bearing to protect the repair. Patients will be expected to use crutches and a brace during this time. Dr. Nwachukwu will prescribe a physical therapy program with gentle stretching exercises to improve range of motion and flexibility. The majority of patients can expect a return to activities between 3-6 months, depending on the severity of the hamstring injury and extent of the surgical repair.

For more information on proximal hamstring repair or to have your hip pain evaluated, please contact the office of Benedict Nwachukwu, MD, orthopedic hip surgeon, serving Manhattan, New York City and surrounding New York boroughs.