Hamstring injuries range from mild strains to complete ruptures. The need for surgery often depends on the severity of the injury and the specific requirements of the individual, especially if the person is an athlete or has specific functional demands.
Several factors influence the outcome of the surgery:
- Type of injury: Proximal hamstring tendon avulsion (where the tendon detaches from the bone at the pelvis) is the most common type of hamstring injury that requires surgical intervention. When the tendon is completely detached, surgical repair often results in better outcomes compared to non-surgical treatments.
- Timing of the surgery: Early surgical intervention (within a few weeks of the injury) tends to result in better outcomes than delayed procedures. Early repair can lead to better muscle function, strength, and scar tissue management.
- Rehabilitation: Post-operative rehabilitation is crucial for a successful outcome. A well-structured rehabilitation program focusing on range of motion, strength, flexibility, and sport-specific activities is essential for optimal recovery.
Return to sport/activity: Many athletes can return to their pre-injury level of sport after hamstring surgery. However, the time to return can vary. Some studies suggest that it can take athletes about nine months post-operatively to return to their sports, but this varies depending on the surgery’s complexity, the individual’s healing rate, and their specific sport.
What Is a Torn Hamstring?
A proximal hamstring tendon avulsion (where the tendon detaches from the bone at the pelvis) is a common type of hamstring injury that requires surgical intervention. While the majority of hamstring tears do not fall into this category, when the tendon becomes detached and retracted off the bone (ischial tuberosity), then surgery is needed.
Proximal hamstring avulsions cause considerable morbidity. The non-operative treatment of complete tears often results in intractable pain, atrophy, and weakness. Therefore, a surgical intervention is often recommended for athletes.
When Do Physicians Recommend Surgery for Hamstring Tears?
As interventional physiatrists, our goal is to help our patients avoid invasive surgeries, BUT there are occasions where surgery is the best option. For example, surgery is required for complete hamstring tears where the tendon is pulled off the bone (retracted).
Types of Hamstring Surgeries
The type of surgery needed depends on the size and location of the tear in the hamstring.
Open Hamstring Muscle Surgery
This is the traditional approach to hamstring repair. A sizeable incision is made over the site of injury to allow direct visualization and access to the torn tendon or muscle.
- Application: This method is often employed for complete proximal tendon avulsions and when a large portion of the tendon or muscle needs to be reattached. It provides the surgeon with the most direct access to repair the injury.
- Recovery: Recovery can be extended due to the invasiveness of the surgery, but it can provide robust outcomes, especially for severe injuries.
Mini-Open Hamstring Muscle Repair
As the name suggests, this is a less invasive approach than the traditional open surgery. A smaller incision is made, but the surgeon still directly visualizes and accesses the injury.
- Application: This is suitable for less severe injuries or when the injury is easily accessible without needing a larger opening.
- Recovery: Generally, the recovery is faster than with the open approach, with less post-operative pain and a smaller scar.
Percutaneous Hamstring Muscle Surgery
This procedure involves making several tiny incisions through which specialized instruments are inserted to repair the injury. It’s even less invasive than the mini-open method.
- Application: It’s often used for injuries that don’t require extensive tissue manipulation or when the injury is in a location that’s easily accessible through a percutaneous approach.
- Recovery: Recovery is typically quicker, with reduced post-operative pain and minimal scarring.
Arthroscopic Hamstring Surgery
This is a minimally invasive procedure where a small camera (arthroscope) is inserted into the joint or tissue space. The camera displays an image on a monitor, and the surgeon uses these images to guide miniature surgical instruments to repair the injury.
- Application: Arthroscopic procedures are often used for injuries within or near joints, making them especially useful for proximal hamstring injuries near the hip joint. They can be beneficial for diagnosing and treating associated intra-articular pathologies.
- Recovery: The advantage of this procedure is that it results in less tissue trauma, which can lead to faster recovery times and reduced post-operative pain.
Factors to Consider Before Undergoing Hamstring Surgery
Before going through with hamstring surgery, it is crucial for patients to carefully consider various factors. These include the severity of the injury, the level of pain and impairment experienced, the potential risks and complications associated with the procedure, and the expected recovery time and rehabilitation process.
Evaluating these factors and discussing them with a healthcare professional can help patients make informed decisions about undergoing hamstring surgery.
Potential Risks of the Procedure
It is important for patients to be aware of the potential risks associated with the procedure, which include:
- Infection: As with any surgery, there’s a risk of wound infection. This is typically addressed with antibiotics if it occurs.
- Nerve injury: The sciatic nerve runs close to the hamstring, and there’s a risk of injury to this nerve during surgery, leading to numbness, tingling, or weakness.
- Hematoma formation: Blood can accumulate at the surgical site, leading to pain and swelling. It might require drainage.
- Scarring: Excessive scar tissue formation might restrict movement and require additional treatment.
- Limited range of motion: Sometimes, despite successful surgical repair, patients may experience limitations in their range of motion.
- Re-rupture: There’s a risk of re-injuring the surgically repaired hamstring, especially if a patient returns to activity too quickly.
- Deep vein thrombosis (DVT): After leg surgery, there’s a risk of blood clot formation, which can be life-threatening if the clot travels to the lungs.
- Chronic pain: Some patients might experience persistent pain at the surgical site or in the surrounding area.
- Unsatisfactory cosmetic result: There might be dissatisfaction with the appearance of the surgical scar or the contour of the operated area.
- Complications from anesthesia: There’s always a small risk associated with anesthesia, including allergic reactions or breathing difficulties.
While the success rate can be high, the complications listed above can be as high as 10% of the time.
Recovery time is variable but patients can take as long as 9-12 months to return to their sporting activity.
Life after the Surgery
While the return to high levels of activity can be achieved with surgery, regaining pre-injury strength in the long term can be problematic.
Non-Surgical Alternatives for Torn Hamstring
Explore non-surgical options for treating torn hamstrings below and discover effective alternatives for a fast and safe recovery.
Non-Steroidal Anti-Inflammatory Drugs
Anti-inflammatory medications, both over-the-counter and prescribed medications, should only be utilized for short durations. In the long term, continual use can have some negative consequences. Check out our five things you need to know about NSAIDs in this article: NSAIDs
Physical Therapy (PT)
As physiatrists, we know the importance of a good physical therapy routine. PT should be part of the rehabilitation process, regardless of other treatment options. Therapy alone, when the injury is more advanced, can only take patients so far. To learn more about PT, see this article on Physical Therapy.
For over 20 years, we have pioneered surgical alternatives utilizing the most advanced orthobiologics to help patients avoid invasive surgeries, from invasive spine fusions and torn ligaments such as ACL to torn rotator cuff tendons. To learn more about the Regenexx Process see this: Regenexx.
For mild to moderate hamstring pathology, such as <50% partial tears to tendinosis, we offer a growth-factor-rich injection to aid your body’s healing cascade, called platelet-rich plasma (PRP). However, not all PRP is created equally. Educate yourself on what you should be looking for by reading this article: PRP Treatment.
Bone Marrow Aspirate Concentrate (BMAC)
For more advanced tears, cellular treatments are mostly needed. We provide this in the form of bone marrow aspirate concentrate (BMAC). This is cellular therapy that has been shown to aid in tendon and ligament repair. It is successful even for full-thickness tears, as long as there is no retraction off the bone.
In the past we have completed randomized control trials on various tendon and ligament tears such as rotator cuffs and anterior cruciate ligament tears, showing success levels of 80-90%. To learn more about this innovative treatment option, see this link: Differences in Bone Marrow Derived Stem Cell Therapies.
Get Proper Treatment for Your Condition
If you are looking to avoid surgery and help your body heal faster and more completely, contact us today and we can set you up with an evaluation with our experts to see if you are a candidate for treatment.