Proximal hamstring repair is an operation to reattach the hamstring tendons to the sitting bone (ischial tuberosity) after a complete or near-complete avulsion injury. These injuries typically occur during sprinting, lunging, or water skiing.
An incision is made in the crease of the buttock. The retracted hamstring tendons are identified, mobilised, and reattached to the ischial tuberosity using suture anchors. The sciatic nerve is carefully identified and protected throughout. The operation takes one and a half to two hours.
Surgery is recommended for complete avulsion of two or more hamstring tendons from the bone, or for significant retraction of the tendons. Without repair, patients experience chronic posterior thigh weakness, pain with sitting, and difficulty running.
Partial tears and single-tendon avulsions may be managed with rest, physiotherapy, and gradual rehabilitation. Complete avulsions managed non-operatively result in significant weakness.
MRI confirms the diagnosis and extent of tendon retraction. Surgery is ideally performed within four weeks of injury. Delayed repair is more difficult.
Restoration of hamstring strength and function. Most patients return to sporting activity, though full strength recovery may take six to twelve months.
Cutaneous nerve branches may be divided, causing numbness on the back of the thigh.
Tenderness over the sitting bone may persist for several months.
Hamstring tightness requiring stretching.
The sciatic nerve is close to the surgical field. Injury can cause leg weakness or numbness. Careful identification reduces this risk.
The repair may fail, particularly with premature loading.
Deep wound infection.
Some degree of strength deficit compared to the uninjured side may persist.
General anaesthesia. The patient is positioned prone (face down).
Crutches for six weeks with restricted hip flexion. A brace may limit range of motion initially. Gentle stretching begins at six weeks. Running at three to four months. Return to sport at six to nine months. Full recovery at nine to twelve months.
Reviews at two weeks, six weeks, three months, and six months.
Proximal hamstring avulsions typically occur during rapid hip flexion with the knee extended, such as during sprinting, water skiing, or a splits-type movement.
The tendons retract after rupture. Early repair (within four weeks) is technically easier and produces better outcomes than delayed repair.