Favorable Results of Proximal Hamstring RepairsWhether you have a partially or completely new or old tear of the proximal hamstring muscle, the results of this study will be of interest. The injury may have come from a sporting activity or blunt trauma. Either way you will be wondering: should I have surgery to reattach or repair the problem? How soon should I have the surgery? Does it matter? Will the results be the same compared with letting it heal on its own?
Twenty-six men and 26 women with proximal hamstring avulsion (tears) were included in the study. As with all muscles, the hamstring muscle attaches in two places. A proximal tear means the muscle has pulled away from its attachment at the top where it attaches to the ischial tuberosity (your "sit bones" -- the place where the pelvic bone rests on the seat of your chair when you are sitting).
Sometimes this type of injury is treated with rest and activity modification (not doing any movements or activities that stress the proximal hamstring muscle attachment). But this approach can take a very long time for healing to occur. And scar tissue around the healing site can also bind down the sciatic nerve causing numbness or pain.
An alternate treatment approach is surgery. Suture anchors are used to reattach and hold the end of the muscle/tendon back on to the ischial tuberosity where it belongs. If the surgery is done within the first 30-days of the injury, it is considered an acute repair. If the procedure isn't done until more than one month after the injury, then it qualifies as a chronic repair.
Although this study did not answer all of the questions posed, it did look at results after both acute and chronic repairs of the proximal hamstring muscle. They used patient satisfaction, pain relief, muscle cramps, and function (including return to sports activities and loss of leg control) as the main measures of outcome or results.
Some of the patients tore their hamstring muscles waterskiing, while others injured themselves running, skiing, or playing a variety of sports (e.g., tennis, football, baseball, softball). Return to full sports participation was somewhat dependent on the type of sport and surgeon recommendation. For example, waterskiing was usually not recommended after a hamstring injury for fear of reinjury.
Although this study did not show a significant difference in results between acute and chronic hamstring repairs, the authors still advise or recommend acute (early repair). Strength and function was slightly better (but not statistically significantly better) in the acute repair group.
In the experience of these orthopedic surgeons, the longer you wait to have the hamstring avulsion surgically corrected, the more difficult it is for the surgeon to find the end of the hamstring, pull it back up to the bone, and reattach it. Likewise, the more time that passes between injury and surgery, the greater the risk of injury to the sciatic nerve.
Patients should be told that even with surgery, they may end up with long-term nerve problems, discomfort when sitting, and numbness over the back of the thigh. Some of these complications occur because the inferior gluteal nerve and the sciatic nerve are retracted (pulled aside) to gain access to the hamstring tendon during the repair procedure. Compression (pinching) of or traction (pulling) on any nerve can result in damage to the nerve and subsequent symptoms.
Steven B. Cohen, MD, et al. Functional Results and Outcomes After Repairs of Proximal Hamstring Avulsions. In The American Journal of Sports Medicine. September 2012. Vol. 40. No. 9. Pp. 2092-2098.
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