Proximal Hamstring Tendon Repair (Revision / Chronic)

⚙️What This Procedure Involves

A transverse incision is made in the gluteal crease. The sciatic nerve is identified and protected — it often runs directly over or through the scar tissue. The retracted hamstring tendons are mobilised (freed from scar tissue), which can be technically demanding in chronic cases. The ischial tuberosity is prepared and the tendons are reattached using suture anchors or through bone tunnels. Allograft augmentation may be needed for severely damaged tendons. The operation takes one and a half to two and a half hours.

💡Why It May Be Recommended

Surgery is recommended for failed primary hamstring repair, chronic hamstring avulsion causing posterior thigh weakness and sitting pain, and retracted proximal hamstring ruptures (typically more than four to six weeks old) in active patients.

⚖️Non-Operative Alternatives

Physiotherapy, activity modification, and acceptance of the strength deficit. Some patients function adequately despite chronic hamstring deficiency, particularly if low-demand.

📋Preparing for Surgery

MRI to assess tendon retraction and quality. Assessment of sciatic nerve relationship to the scar. Pre-operative physiotherapy (prehabilitation).

✅Expected Benefits

Restoration of hamstring strength and reduction of sitting pain. Outcomes for chronic repair are less predictable than acute repair — approximately 70–80% of patients report significant improvement.

⚠️Common Risks

• Sciatic nerve irritationCommon

  The nerve is often embedded in scar tissue. Temporary numbness or tingling is common post-operatively.

• Sitting discomfortCommon

  May persist for months.

• Incomplete strength recoveryExpected

  Strength rarely returns to 100% in chronic cases.

🔴Less Common but Serious Risks

• Sciatic nerve injuryUncommon

  Permanent damage is rare but the nerve is at significant risk in revision/chronic surgery.

• Re-ruptureUncommon

  The repair may fail again.

• InfectionRare

  Wound infection.

• HaematomaUncommon

  Blood collection in the posterior thigh.

💉Anaesthetic Considerations

General anaesthesia. Prone position.

🏃Recovery and Rehabilitation

Crutches for six weeks. Avoid sitting on hard surfaces for six weeks. Prone lying and gentle stretching. Progressive strengthening from six to eight weeks. Running at four to six months. Return to sport at six to nine months.

📅Follow-Up

Reviews at two weeks, six weeks, three months, and six months.

❓Frequently Asked Questions