Proximal Hamstring Repair
Understanding the Anatomy
The hamstring muscles are a group of three muscles located at the back of the thigh — the biceps femoris, semitendinosus, and semimembranosus. The biceps femoris and semitendinosus combine to form a conjoint tendon proximally. These muscles originate from the ischial tuberosity, which is a bony prominence at the base of the pelvis.
Together, they play an essential role in hip extension (moving the leg backward) and knee flexion (bending the knee). The hamstrings are especially active during running, sprinting, and explosive athletic movements. The siatic nerve runs next to these tendons which provides motor function to the lower leg.
Who Should Have a Proximal Hamstring Repair?
A proximal hamstring repair is typically recommended for:
Complete tears (avulsions) of the hamstring tendons from the bone.
Partial tears involving most of the tendon thickness that fail to improve with non-surgical treatment.
Patients who experience persistent pain, weakness, or loss of function after a significant hamstring injury.
This procedure is often indicated in active individuals or athletes who need to restore strength and power for running, jumping, or pivoting activities.
How is the surgery performed?
Proximal hamstring repair is performed under a general anesthetic.
The surgery can either be performed via a small incision on the gluteal crease or via keyhole surgery with a small camera and small tools.
The tendons are identified, cleaned, and reattached to the ischial tuberosity using strong sutures and small anchors that secure them to the bone.
In some cases, if the tear is chronic and the tendons have retracted, the surgeon may need to mobilize the tissue or use a graft to bridge the gap.
The operation typically takes 1.5–2 hours and patients usually return home the following morning.
Recovery After Surgery
Recovery involves a combination of protection, gradual motion, and strengthening:
Day after surgery: You will be admitted to hospital for 1-3 days. A physiotherapist will be working with your within 24 hours after your surgery.
First 6 weeks: You will walk partially weight-bearing with crutches. A knee brace may be used for significantly retracted tears but most cases will not require bracing. Gentle passive range of motion can start until mild pain starts to be experienced. Sitting down with a straight knee should be avoided in this period.
6–12 weeks: Gentle active range of motion and light strengthening exercises are introduced under physiotherapy supervision. You can walk without crutches in this period.
3–6 months: Progressive strengthening and conditioning exercises focus on restoring muscle control and endurance. It is ok to gradually return to running.
6–12 months: Return to sport-specific training and full activities once strength and motion are restored.
How to Manage My Wound
Proper wound care is essential for healing and to prevent infection.
Dressings: Your wound will be covered with a sterile dressing after surgery. You should keep this dressing on for 2 weeks. If it falls off, please contact our office.
Showering: You may shower with the waterproof on. Avoid soaking the wound (no baths, pools, or spas) for 4 weeks.
Monitoring: Check the incision daily for signs of infection such as redness, foul smell drainage, or unusual pain. Fever is another sign of infection. Please call our wounds if there are any issues.
Sutures: Your wound should be checked by your GP in 2 weeks. Your wound will be closed with absorbable sutures which do not require removal. Sometimes the sutures do not dissolve and will be pushed out by the skin.
Clothing and Sitting: Avoid tight clothing or prolonged sitting directly on the wound for the first 2-3 weeks to reduce pressure and irritation.
When Can I Return to Activities?
Walking: You should start walking with crutches right away.
Pool therapy: Usually permitted around 6 weeks.
Cycling: No resistance training can start in 4 weeks with very gradual resistance starting at 6 weeks.
Running: Most patients can resume jogging between 3–6 months, depending on progress and physiotherapy goals.
Full sports participation: Generally between 6–12 months, sometimes longer for elite athletes.
When Can I Return to Work?
Sedentary work: Most people can return after 2–4 weeks, depending on comfort and mobility.
Light manual work: Typically around 8–10 weeks.
Heavy labour or physically demanding jobs: Often require 3–5 months before safely returning.
When Can I Return to Driving?
Driving can usually resume when you can safely control the pedals without pain or restriction, typically around 2–4 weeks after surgery for the left leg (automatic vehicle) and 8–10 weeks for the right leg. You must be off of any narcotics before you drive.
What Complications Occur?
While proximal hamstring repair is a safe and effective procedure, all surgeries carry some risk. Potential complications include:
Nerve irritation/injury: Temporary numbness or tingling in the back of the thigh or leg due to proximity to the sciatic nerve. It is important to move your hip early to allow the sciatic nerve to glide naturally so scar tissue does not grow around it. There is a low risk of sciatic nerve injury, which would lead to disability in the function of the lower extremity.
Wound complications: Infection, delayed healing, or sensitivity around the incision site.
Re-tear or incomplete healing: Particularly if the tendon was significantly retracted, poor tissue quality, or under high tension.
Stiffness or weakness
Deep vein thrombosis/Pulmonary Embolism (DVT): preventive measures are used to reduce this risk by prescribing blood-thinning medication such as aspirin.
Heterotopic ossification: This is the formation of bone in the soft tissue which can cause pain. This is prevented by taking naproxen for 3 weeks after surgery if you do not have medical contraindications (kidney disease, stomach ulcers)
Persistent discomfort when sitting: Occasionally reported after repair due to scar sensitivity.
