Proximal Hamstring Repair

The Hamstring muscles run from the buttock down the back of the thigh andacross the back of the knee. Most Hamstring injuries occur in the middle ofthe muscle belly, and will heal completely without the need for surgery.However when the hamstrings are injured at the top end, the tendon can pulloff the bone. In this case surgery is usually recommended to re-attach thedamaged tendons.

Sometimes repetitive minor injuries can cause the tendons to becomethickened, frayed and painful. Surgery may also be helpful for this condition ifother methods have not worked.

The Operation

The operation is completed under general anaesthesia and you lay prone (onyour stomach). The surgery is done through either a 10-15cm transverse(sideways) or longitudinal (lengthwise) incision over the buttock crease. Weprefer (when indicated) to perform the transverse bikini line incision forcosmesis. The main (sciatic) nerve sits next to the hamstrings, so must befound and protected. The torn tendons are then reattached to the bone usingsuture anchors, which sit inside the bone. The skin is closed with a dissolvingstitch. The operation takes ~90 minutes in total. 

Post Surgery

First 24 hours

  • You will be kept comfortable on the ward with medication. If a nerve block was used your leg may be numb for 24 hours.

  • You may have a brace on your leg to prevent overstretch and damage to the tendon repair. The physiotherapist will instruct on how to wear the brace and how to adjust it.

  • The physiotherapist will also help you with advice to assist with reducing sitting discomfort following surgery.

Day 1-3

  • You must avoid too much hip flexion (bring knee up to chest) with the knee straight.

  • Ice - 20 mins every 2-3 hrs.

  • Walk with the ward physiotherapist, using crutches.

  • You will be allowed to touch weight bear only (this means putting your toes down for some balance only)

  • Home exercise programme as advised by the physiotherapist.

  • Education with regards to sitting and car transfers.

  • Home on day 1-2 post surgery.

  • Tummy time - lie prone up to 2 hours per day to assist with wound healing.

First 2 weeks

  • Continue to walk touch weight bearing using crutches

  • Keep the wound covered with the dressing placed in hospital

  • Take oral painkillers and anti-inflammatories

  • Contact my rooms to arrange an appointment at 10 days post surgery (this coincides with expected wound healing and coverage)

  • Tummy time and ice continued.

Weeks 2-6

  • Gradually progress off crutches in next 2 weeks and can stop using brace at 4 weeks (*If you have been told to wear one).

  • You can start driving short distances

  • Gentle hip bending exercises, calf stretching, Isometric I hamstring holds, modified squats (similar to sit to stand action), exercise bike can start as comfort allows.

After 6 weeks

  • Increasing walking distance as comfortable

  • Progress from 2 leg to 1 leg exercises (bridges, 1 leg squats, lunges)

  • Exercise bike increasing intensity and swimming

  • Gradually build resistance training with bands or in gym

  • Gradually introduce jogging to running as strength improves

  • Full activities and sport from 3-6 months (depending on progress andsport)

  • The physiotherapist will demonstrate and provide the rehabilitation details at the 10-14day follow-up appointment and ensure these are done correctly and safely.

Other information

Sitting discomfort

Due to the location of the tendon repair and wound, sitting may be painful forup to 4-6 weeks. Some discomfort on prolonged sitting may persist for 6months.

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