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Hamstring Surgery
Hamstring injuries are extremely common in sport. They can occur through repetitive use or over use or through sudden contractions or sudden stretch.
About Hamstring Surgery
A number of mechanisms have been described and an individual’s sporting endeavours and function will determine quite how strong and flexible their hamstrings are and which of the hamstring muscles or tendons they injury.
Major hamstring injuries are not only common but the recur frequently and lead to loss of speed and performance. They can be extremely frustrating for athletic individuals.
The majority of hamstring injuries can be managed non-operatively with appropriate healing time and physiotherapy. Occasionally injections are used although the evidence base for this is limited.
There have been increasing interest in surgery for hamstring injuries based on the gravity of these injuries, the risk of loss of function and in particular the risk of recurrent injuries and recurrent inability to perform sport.
Our group has led the way on the evaluation and management of these injuries with multiple publications as referenced below. In effect it is important to have a high index of suspicion with a major hamstring injury particularly is there is a pop, if there is an inability to walk properly or if bruising comes out or if symptoms don’t settle rapidly. In those scenarios MRI scan imaging is the standard and then determines the anatomy of the injury and the likely consequences. There are multiple incidences where surgery is invoked for hamstring injuries particularly in elite sport. This is partly to restore function but also partly to reduce the risk of recurrent injuries. The exact type of lesion will determine whether surgery is needed and how quickly it needs to be performed and how it is performed whether it is by reattachment to bone or by tendon to tendon repair. We have published extensively on all of these areas in the orthopaedic and sports medicine literature.
From a patient perspective hamstring repair is typically a day case procedure. Patients can walk out of hospital with crutches although occasionally a brace is used to limit hamstring stretch depending on the delay between injury and repair and the needs and desires of the patient. You and your physiotherapist would be given a rehabilitation programme to follow.
There are, of course, risks to any intervention and the risks of hamstring surgery include general anaesthesia, blood clots, infections, nerve injuries, deep scarring and superficial scar problems and numbness. These frequently are very rare particularly because we undertake this surgery frequently. The benefits of undertaking hamstring surgery are to restore anatomy and reduce the risk of scar into the sciatic nerve and its branches and to reduce the risk of re-injury. This is particularly important in unstable injuries such as retracted proximal tears or displaced tears of the T-junction.
Decision making will always take into account a patient’s activity profile, their anatomy, the energy of the injury and the functional needs of the individual in question.