What is Proximal Hamstring Repair?
The proximal hamstring refers to the upper part of the hamstring muscle group located at the back of the thigh, where the muscles attach to the pelvis. The hamstring muscles (biceps femoris, semitendinosus, and semimembranosus) are crucial for activities that involve bending the knee and extending the hip, such as running, jumping, and walking.
A proximal hamstring tear occurs when one or more of these muscles tear or rupture where they attach to the pelvis, often due to sudden movements or overuse. This injury can be painful, disabling, and significantly impact a person’s ability to perform everyday tasks or athletic activities.
A proximal hamstring repair is a surgical procedure performed to reattach the torn tendon(s) to the pelvis, restoring the function and strength of the hamstring muscles.
Why is Proximal Hamstring Repair Needed?
Proximal hamstring tears can occur due to:
- Acute injury: A sudden, forceful movement like sprinting, jumping, or a deep squat.
- Chronic injury: Overuse, particularly in athletes or individuals involved in activities that require repetitive high-intensity movements.
- Trauma: A direct blow to the back of the thigh can lead to tendon damage.
Surgical repair may be necessary when:
- The tear is severe (i.e., the tendon is completely detached from the pelvis).
- Conservative treatments (such as rest, physical therapy, and anti-inflammatory medications) fail to alleviate pain or restore function.
- The patient is unable to return to normal activities or sports due to ongoing pain, weakness, or instability in the thigh.
How is Proximal Hamstring Repair Performed?
Proximal hamstring repair is typically performed using arthroscopic or minimally invasive techniques, although in some cases, open surgery may be required depending on the severity of the injury.
Steps of the Procedure:
- Anesthesia: The procedure is typically performed under general anesthesia or regional anesthesia (spinal or nerve block), depending on the patient’s needs and surgeon’s preference.
- Incision: A small incision is made at the back of the thigh where the hamstring tendons are torn. In some cases, arthroscopic surgery may be used to create smaller incisions and use a camera to visualize the injury.
- Repairing the Tendon:
- If the tendon is partially torn, the surgeon will carefully suture the tendon back into its original attachment site on the pelvis.
- If the tendon is completely torn or detached, the surgeon will reattach the tendon to the bone using sutures or anchors. In some cases, tendon grafts (from other areas of the body or from a donor) may be used if there is not enough tissue to repair the tendon.
- Releasing Tension and Stabilization: The surgeon ensures the tendon is securely fixed to the bone and free from tension to allow for proper healing. Once the tendon is repaired, the incision is closed using sutures or staples.
- Recovery: After the repair, a post-operative rehabilitation plan will be initiated to promote healing and restore strength and function to the hamstring.
The procedure typically takes 1 to 2 hours depending on the complexity of the tear and repair.
Post-Surgery Care and Recovery:
Immediate Post-Surgery (First Few Days):
- Pain and Swelling: After surgery, you will experience some pain and swelling around the back of the thigh. Ice, compression, and prescribed pain medications can help manage these symptoms.
- Rest and Elevation: You will need to elevate your leg as much as possible to reduce swelling, especially in the first few days.
- Bandaging and Wound Care: Keep the incision site clean and dry. Your surgeon will provide instructions on how to care for your surgical site to prevent infection.
- Use of Crutches: You will likely use crutches or a walker for several weeks to avoid putting weight on the affected leg.
Rehabilitation (Physical Therapy):
Rehabilitation is essential to regain mobility, strength, and flexibility in the hamstring and thigh muscles.
- Phase 1 (0-4 weeks): Focus is on managing pain and swelling, and protecting the tendon from excessive strain. Passive range-of-motion exercises may be introduced.
- Phase 2 (4-8 weeks): Gradual return to weight-bearing activities as healing progresses. Light stretching and strengthening exercises will begin to restore flexibility and function.
- Phase 3 (8-12 weeks): More intense strengthening exercises will be introduced. These exercises focus on restoring strength to the hamstring and surrounding muscles, including the glutes and quadriceps.
- Phase 4 (3-6 months): As healing continues, you will work on improving endurance, agility, and dynamic movements. Depending on your progress, your physical therapist may gradually reintroduce sports-specific movements.
- Phase 5 (6-12 months): Most patients return to regular physical activities and sports during this phase, although it is important to follow a gradual and supervised return-to-play program.
Long-Term Recovery:
Full recovery from a proximal hamstring repair can take 6 to 12 months, especially for athletes. It is essential to follow the rehabilitation plan carefully to restore full function and avoid reinjury.
Potential Risks and Complications:
While proximal hamstring repair is generally a safe procedure, there are potential risks and complications to be aware of, including:
- Infection: There is a risk of infection at the incision site, which can lead to delayed healing or the need for additional treatments.
- Blood clots: Blood clots may form in the veins of the leg after surgery, especially if the leg is immobilized for long periods.
- Nerve damage: There is a small risk of nerve injury during surgery, which can lead to numbness or weakness in the leg.
- Re-tearing or failure of the repair: If the tendon does not heal properly, there may be a re-injury, which could require further surgical intervention.
- Stiffness or decreased range of motion: Some patients may experience stiffness in the hip or knee joint after surgery.
- Scar tissue formation: The development of scar tissue may limit movement and cause discomfort during the recovery process.
Benefits of Proximal Hamstring Repair:
- Pain Relief: One of the primary benefits of surgery is the reduction or elimination of pain caused by the hamstring tear.
- Restoration of Function: The repair allows for the restoration of the hamstring’s ability to bend the knee and extend the hip, enabling patients to return to daily activities and sports.
- Minimally Invasive Options: If performed arthroscopically, the surgery typically involves smaller incisions and a shorter recovery time compared to traditional open surgery.
- Improved Strength and Stability: Once the tendon heals, the hamstring’s strength and function are typically restored, improving overall leg stability and mobility.
Long-Term Outlook:
- Most patients who undergo proximal hamstring repair experience significant improvement in pain and function. With proper rehabilitation and gradual return to activity, most individuals can regain full strength and return to their prior level of activity.
- Recovery times vary depending on the severity of the tear, the type of surgery performed, and the patient’s commitment to rehabilitation. Athletes can expect to return to sport in 6 to 12 months, while non-athletes may return to normal daily activities sooner.
When to Contact Your Surgeon:
You should contact your surgeon if you experience:
- Signs of infection, such as fever, redness, warmth, or drainage from the surgical site.
- Severe pain or discomfort that is not relieved by prescribed medications.
- Increased swelling or bruising that doesn’t improve.
- Numbness, tingling, or weakness in the leg or foot.
- Difficulty moving your leg or resuming basic activities.
Conclusion:
Proximal hamstring repair is an effective surgical treatment for patients with hamstring tendon injuries that don’t heal with conservative treatments. The procedure helps restore strength, mobility, and function to the affected leg, allowing patients to return to daily activities and sports with less pain and improved performance.
If you have suffered a proximal hamstring injury, we are happy to take care of you!