Hamstring Tendon Tear

Hamstring Injury

Hamstring injuries are common in athletes who participate in sports activities such as track, soccer, and basketball that involve running. The three hamstring muscles namely semitendinosus, semimembranosus and biceps femoris are at the back of the thigh and helps you bend (flex) your knee and extend your hip.

Injuries to the hamstring group of muscles can range from a minor strain to a complete tear. Avulsion injury occurs when the hamstring muscle tendon completely tears away from the bone. Sometimes, the tendon may even pull off a piece of bone along with it.

Complete Hamstring Tendon Tear

Hamstring tendon avulsions are caused by a sudden contraction of the hamstring muscle during strenuous exercise. A sudden jump, overstretch, or large sudden load to the muscle can increase your risk of hamstring avulsion injury. Often this occurs with water skiing.

Complete hamstring avulsions are often difficult to differentiate from simple strains. Diagnosis is made through the symptoms and physical examination. During the physical examination, your doctor will examine your thigh for tenderness and bruising as well as check for signs of pain, swelling and weakness in the back of your thigh. Your doctor may order an X-ray to see whether the avulsed tendon has pulled away a small piece of bone and MRI scan to determine the severity of your injury.

Initial treatment for hamstring injuries involves rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling.

Complete hamstring avulsion is a serious injury that may require surgery. During the tendon avulsion repair, hamstring muscles are pulled back to its normal attachment. Your surgeon reattaches the hamstring tendon to the bone using suture anchors.

After surgery, you may need to use crutches and a brace to protect and keep your hamstring muscle in relaxed position. Your doctor will recommend physical therapy which involves gentle stretching exercises in order to restore normal function. Rehabilitation period of at least 3 to 6 months may be needed before returning to athletic activities.

Partial Hamstring Tendon Tear

A less acute injury to the hamstring tendon is called a partial hamstring tendon tear. This sometimes is brought on by a specific injury event but can be insidious in onset. In partial tears, the tendon is detached from bone but has not retracted. This often manifests as pain in the buttock, worse with sitting, walking, running and standing. An MRI is needed in order to confirm the diagnosis. Initial treatments consist of activity modification, physical therapy and anti- inflammatory medication. Injections of PRP or cortisone are also helpful. These are done with ultrasound guidance. If these measures are unable to improve the pain and function of the hamstring, surgery is done to repair the torn tendon. This endoscopic procedure is done through three small incisions as an outpatient. Suture anchors are used to repair the tendon back to bone.

Research Publications

Endoscopic Transtendinous Repair for Partial-Thickness Proximal Hamstring Tendon Tears

Hamstring tears are common injuries in athletes, with most injuries occurring at the myotendinous junction from combined hip flexion and knee extension. Most of these injuries can be successfully managed with conservative treatment.1 Injuries to the tendinous insertion are less commonly reported and partial tears even less commonly.