Hamstring Tendon Repair

Hamstring tendon repair is a surgical procedure used to reattach one or more hamstring tendons back to the bone after they have torn away. The hamstring muscles run along the back of the thigh and attach to the pelvis (ischial tuberosity) at the top and to the lower leg bones at the knee. These muscles are essential for walking, running, bending the knee, and controlling hip movement.

Hamstring tendon injuries can range from mild muscle strains to complete tendon ruptures. In more severe cases in active people, particularly when the tendon is completely torn from the bone (an avulsion), surgery can be considered. Hamstring tendon repair aims to restore normal anatomy by securing the torn tendon back to the bone using surgical anchors. This helps improve strength, reduce pain, and allow a return to normal activities.

Who is Suitable for Hamstring Tendon Repair?

Many mild-to-moderate hamstring strains heal well with rest and physiotherapy. Hamstring tendon repair is generally recommended for active patients with acute avulsion injuries of 2 or 3 tendons. For older, less active patients, non-operative management of even severe injuries can result in an acceptable functional recovery.

People who may be suitable include:

Patients with complete tendon rupture: Where one or more hamstring tendons have fully torn away from the bone
Individuals with significant tendon retraction: Where the tendon has pulled back several centimetres, making natural healing unlikely
Active individuals or athletes: Especially those who wish to return to running, sport, or physically demanding work
Patients with ongoing pain or weakness: Despite appropriate non-surgical treatment such as physiotherapy
Recent injuries: Surgery tends to be more successful when performed within weeks of the injury rather than months later

Hamstring tendon repair may be less suitable for individuals with low activity demands, significant medical conditions that increase surgical risk, or long-standing injuries in which tendon and muscle quality have deteriorated.

Benefits of Hamstring Tendon Repair

Key benefits include:

Improved strength: Reattachment of the tendon allows better recovery of hamstring power
Reduced pain: Chronic pain caused by tendon retraction or irritation is often reduced
Improved mobility: Patients can usually return to walking, running, and sitting more comfortably
Better functional outcomes: Particularly for sports, exercise, and physically demanding jobs
Reduced risk of long-term complications: Such as chronic weakness, nerve irritation, or altered gait
Higher likelihood of returning to sport: Compared with non-surgical treatment for complete tears

Many patients report significant improvement in quality of life after surgery, particularly when repair is performed early and followed by structured rehabilitation.

Alternative Options to Hamstring Tendon Repair

Not all hamstring tendon injuries require surgery. Non-surgical management can be very successful depending on the injury type and patient needs.

Components of non-operative management can include:

Rest and activity modification
Structured physiotherapy program
Pain management
Injection therapy (such as PRP injections in some instances)
Accepting functional limitations

It is important to note that although non-surgical treatments can be effective for partial tendon injuries, they are generally less effective for complete tendon ruptures, particularly in active individuals. Delaying surgery in suitable cases may reduce the chance of full recovery.

Hamstring Tendon Repair Procedure

Dr Williams performs hamstring tendon repair as an open procedure under general anaesthesia. The exact technique depends on the type of tear and whether the injury is acute or chronic.

The procedure usually involves the following steps:

Positioning: You are positioned carefully, lying face down to allow access to the posterior thigh and pelvis while protecting nerves and pressure points.
Surgical exposure: Dr Williams makes an incision over the injured area, near the buttocks, for proximal hamstring tears. For most acute cases with minimal retraction, Dr Williams uses a horizontal incision in the buttock crease, which hides the scar. For more chronic or difficult cases, a vertical incision is generally used.
Identification of the tendon: The torn tendon ends are located and gently freed from surrounding scar tissue if required. The sciatic nerve is also carefully identified and protected to prevent injury.
Bone preparation: The area of bone where the tendon originally attached is prepared to promote healing.
Tendon reattachment: Strong sutures and anchors are used to secure the tendon back to the bone in its correct anatomical position.
Stability check: The repair is tested to ensure it is secure and free of excessive tension.
Closure: Dr Williams closes the wound in layers, with the last layer being a buried dissolvable suture below the skin, reinforced by surgical glue. As such, there are no sutures to remove.

Surgery usually takes between one and two hours.

What to Expect After a Hamstring Tendon Repair?

In the early recovery period, patients can expect:

Hospital stay: Many patients go home after one night in the hospital.
Pain and swelling: These are expected initially and are managed with medication, ice, and rest.
Restricted movement: You may be required to use crutches to support weight-bearing for several weeks. Hip and knee positions that stretch the hamstrings are to be strictly avoided for 6 weeks.
Bracing: Dr Williams usually doesn’t require you to wear a brace, although it may be required in chronic cases to protect the repair.
Wound care: Dressings are kept clean and dry, with follow-up appointments to monitor healing.

As recovery progresses:

Physiotherapy: A supervised rehabilitation program begins with a gentle range-of-motion focus, followed by gradual strengthening.
Return to daily activities: Sitting, walking, and driving are reintroduced gradually, guided by comfort and strength.
Return to sport or heavy work: This typically occurs several months after surgery, often between 6 and 9 months, depending on the severity of the injury and individual progress.

Adhering closely to rehabilitation guidelines is critical. Pushing too hard too early can compromise the repair, while insufficient rehabilitation may lead to stiffness and weakness.

Hamstring Tendon Repair Prognosis

The overall prognosis after hamstring tendon repair is generally good, particularly when surgery is performed early and followed by appropriate rehabilitation.

Expected outcomes include:

Pain reduction: Most patients experience a significant reduction in pain compared with preoperative symptoms.
Strength recovery: Many patients regain near-normal hamstring strength over time.
Excellent function: Walking, sitting, running, and sporting activities are usually possible at pre-injury levels for most patients.
Return to sport: Many active individuals return to their previous level of sport, although this may take several months.

Prognosis is influenced by several factors, including:

Timing of surgery: Acute repairs tend to have better outcomes than delayed repairs.
Extent of injury: Complete multi-tendon avulsions may require longer recovery.
Patient age and health: Younger, healthier individuals often heal faster.
Commitment to rehabilitation: Consistent physiotherapy significantly improves results.

While full recovery is common, some patients may notice minor residual stiffness or strength differences compared to the uninjured side.

Hamstring Tendon Repair Risks

Possible risks include:

Infection: Rare, but may require antibiotics or further treatment.
Bleeding or haematoma: Collection of blood near the surgical site.
Nerve irritation or injury: The sciatic nerve runs near the hamstring origin and may be irritated, resulting in numbness or tingling. Very rarely, an injury may cause temporary or permanent weakness of the muscles below the knee.
Blood clots: Deep vein thrombosis can occur, particularly with reduced mobility.
Stiffness or weakness: Especially if rehabilitation is delayed or incomplete.
Re-tear or repair failure: Uncommon, but more likely if post-operative restrictions are not followed.
Scarring or cosmetic concerns: Some patients notice scarring or local tenderness.

Dr Williams will discuss these risks in detail and take steps to minimise them through careful technique and post-operative care.

What if Hamstring Tendon Repair is Delayed?

Potential consequences of delayed treatment include:

Chronic pain: Ongoing discomfort when sitting, walking, or exercising.
Persistent weakness: Reduced hamstring strength and endurance.
Tendon retraction: The tendon may pull further away from the bone, making repair more difficult.
Muscle degeneration: Long-standing injuries can lead to muscle wasting and fatty infiltration.
Altered movement patterns: Compensation can cause problems in the lower back, hip, or knee.
Reduced surgical success: Delayed repairs may require more complex techniques and have less predictable outcomes.

Not all delayed cases require surgery. Some individuals with lower activity demands can manage symptoms with physiotherapy and activity modification. Considering that surgery for delayed cases carries increased risk and the potential for poorer outcomes, the decision depends on pain, functional limitation, and personal goals.

What is Hamstring Tendon Repair?