Proximal Hamstring Rupture
What are Hamstring Muscles?
The hamstring muscles are three muscles at the back of the thigh that are commonly injured during sports that involve running, jumping and sudden changes in speed. Injury usually occurs at the proximal tendinous origin of the muscles which attach to the ischium, a pelvic bone. The risk of injury increases with age, prior injury, lack of flexibility and being overweight.
Treatments for Proximal Hamstring Rupture
Strains of the hamstring are usually treated by non-operative means such as compression and limiting weight bearing. Complete rupture of the hamstrings requires surgical correction. Hamstring injuries are usually acute and associated with sudden pain, muscle spasm, and difficulty walking. A pop may occasionally be felt or heard. The back of the thigh is usually bruised and tender and swelling may be present.
Your doctor will order imaging studies to view the area of injury. In case of a complete rupture, the tendon may be pulled away or retracted from the site surgically. If there is minimal retraction ( < 2 cm) or if fewer tendons are involved, then a nonsurgical approach may be appropriate. Surgery is recommended when there is greater retraction and return to sports and strenuous activity is desired.
If treatment is delayed, your symptoms usually intensify with more muscle atrophy and weakness. Acute repair of complete ruptures has better outcomes.
Surgical Procedure to Treat Proximal Hamstring Rupture
Surgery is performed under general anesthesia and you will lie face down for the procedure. Two or more portals are introduced through small incisions in the buttock fold. Care is taken not to injure the sciatic nerve and other important neurovascular structures. An arthroscope is inserted into one of the portals to view the surgical site and the operation is performed with the help of instruments through the other portals. Any blood collection or scar tissue is removed. If a tendon stump is present on the ischium, it is removed. The ruptured tendon is identified and reattached to the ischial tuberosity with sutures. In case of chronic injuries, there may be significant scar tissue involving the sciatic nerve and muscle making reattachment difficult. Sciatic neurolysis and the use of an allograft may be necessary. Once repair is complete, the instruments are removed, the incisions are closed and a sterile dressing is placed.
Post-procedural Care of Proximal Hamstring Rupture
Following surgery, you will be on crutches with limited (toe touch) weight bearing. You will have to avoid movements such as bending your hip, extending your knee and other activities that strain the hamstrings. Braces are worn for 6 weeks to help you limit range of motion. You will then gradually increase weight bearing and range of motion. Hamstring exercises as well as core and hip stabilizing exercises are introduced, and you can safely return to sports in about 6 months.