Hamstring Repair at North Staffordshire Hospital

What is hamstring repair?

Hamstring repair is an operation to fix a torn hamstring tendon or muscle at the back of your thigh. Your surgeon reattaches the torn end to where it should naturally sit and secures it in place with stitches and bone anchors.

What conditions does it treat?

Hamstring repair treats tears in the hamstring muscles or tendons at the back of your thigh. There are three hamstring muscles (semimembranosus, semitendinosus and biceps femoris), which run from your pelvis to below your knee and work to straighten your hip and bend your knee.

A tear can range from a strain to a partial or complete rupture. When the tendon pulls away from where it attaches to the bone, this is called an avulsion. Tears are usually caused by a sudden injury, often when the muscle is stretched while trying to contract, or overloaded beyond its limit, such as during sprinting or jumping, though a direct blow or fall can also cause one.

While a simple strain can often be treated without surgery, a complete avulsion, especially one affecting the sciatic nerve, usually needs an operation. A complete tear can cause swelling and bruising below the buttock, and weakness in the hamstring muscles.

What are the benefits of hamstring repair?

Hamstring repair surgery aims to:

• restore the strength and function of your hamstring muscles
• improve pain
• improve your overall mobility and quality of life
• reduce the risk of scar tissue affecting the sciatic nerve
• reduce the risk of re-injury, which is particularly important for unstable tears.

Are there different surgical approaches?

There’s more than one way your surgeon might repair a torn hamstring, depending on where the tear is and how it happened.

The main approach is open surgery, using an incision below your buttock fold, in the natural skin crease there to help with scarring. The length of the cut depends on how far the tendon has pulled back down your thigh.

Depending on the type of tear, your surgeon may reattach the tendon directly to the bone using anchors, or repair tendon to tendon if that’s where the injury has occurred.

What happens before the procedure?

If you have a major hamstring injury, especially if you heard or felt a ‘pop’, can’t walk properly, have bruising, or your symptoms aren’t settling quickly, your doctor is likely to arrange an MRI scan. This shows the exact anatomy of the tear and helps decide whether you need surgery, and how urgently.

In general, the longer the delay after the initial injury, the harder it becomes to release and reposition the tendon, so earlier treatment is preferred where possible.

Your surgical team will take into account your activity levels, anatomy, the severity of the injury and your individual functional needs when planning your surgery.

What happens during the procedure?

1. You lie face down (prone position) on the operating table.
2. Your surgeon makes a cut, usually along the fold below your buttock, over the affected side.
3. The tissue layers are carefully opened to reach the area, and the muscle above (gluteus maximus) is gently moved out of the way.
4. Your surgeon identifies and protects the sciatic nerve, which runs close by, freeing it from any scar tissue if needed.
5. Any blood or fluid built up around the injury is cleared away, and scar tissue is removed so the tendon can be fully freed and moved.
6. Stitches are placed through the tendon to help pull it back into its natural position.
7. The tendon is reattached to the bone using anchors, or stitched tendon-to-tendon, depending on where the tear is.
8. The wound is closed in layers.

Your operation can take between 1–3 hours, depending on how much work needs to be done.

What does recovery look like?

In hospital

Local anaesthetic is used at the end of your operation to numb the pain, and it’s normal for this to wear off and for pain to return, so you’ll need to take regular painkillers as prescribed. You may need to stay in hospital for 1 or 2 nights depending on the extent of your surgery, your medical history, and how well you’re managing to mobilise with the physiotherapists.

A physiotherapist will see you on the ward and help you get moving safely with crutches, usually without putting weight on the operated leg for up to 6 weeks. Many people are also fitted with a knee scooter to help with mobilising.

At home

You’ll usually be fitted with a brace holding your knee bent for around 4–6 weeks, to protect the repair while it heals. It’s normal for your wound to leak a little blood or fluid for the first few days; keep it clean and dry, and redress it if the dressing becomes soaked. Dissolvable stitches don’t need to be removed.

Try to get back to your normal daily routine as soon as you can. You’re likely to need help with mobility and self-care at first, but most people are independent again by the time they leave hospital. You shouldn’t drive while you’re still on crutches or wearing the brace; once you can safely perform an emergency stop, usually around 6–8 weeks after surgery, you may be able to start driving again, though you should check with your insurer first.

Your return to work depends on your job: it may take a couple of weeks for an office-based role, and longer for physical work. Your rehabilitation will be guided in phases by your physiotherapist. In broad terms:

• weight on the leg is gradually increased, aiming for full weight-bearing by around 6 weeks
• scar tissue massage usually starts from around 4 weeks
• gentle hamstring stretching is introduced from around 3 months
• resisted hamstring strengthening exercises begin from around 4 months
• high-impact activities and plyometrics start from around 6 months.

What are the risks and complications?

As with any operation, there are risks to be aware of:

• infection of the wound, or deeper infection
• injury to the sciatic nerve
• the repair failing to hold if the tear was long-standing before surgery
• the tendons failing to heal, or symptoms coming back
• re-injury, or needing further surgery
• not feeling fully satisfied if your symptoms don’t improve as hoped
• a heart attack or chest infection
• a blood clot in the veins of your leg, which can occasionally travel to your lungs (deep vein thrombosis and pulmonary embolism).