The injury
The three hamstring muscles attach to the ischial tuberosity at the base of the pelvis. A forceful eccentric load — typically water-skiing, hurdling or a slip into the splits — can detach all three tendons from their bony attachment. Patients describe a sudden tearing sensation followed by severe buttock pain and difficulty walking.
Diagnosis
The diagnosis is suspected from the history and a clinical examination showing bruising and a palpable defect. MRI is the investigation of choice and shows the number of tendons involved and the degree of retraction.
Why surgical repair?
- Non-surgical management — around 50% of normal hamstring strength is recovered.
- Surgical repair — around 90% of normal hamstring strength is recovered.
For most active patients, surgical repair is recommended — particularly when surgery can be performed within a few weeks of the injury.
The operation
The patient is positioned prone (face down) under general anaesthesia. A 10–15 cm incision is made over the buttock crease. The torn tendons are mobilised and re-attached to the ischial tuberosity using suture anchors. The procedure takes between 90 minutes and four hours depending on complexity.
Recovery
- Crutches with touch weight-bearing for the first two weeks.
- Gradual increase in weight-bearing as comfort allows.
- Physiotherapy throughout to regain range of motion and strength.
- Return to full activities at 6–12 months depending on the demands of the sport or occupation.
Complications
As with any surgery, complications can include infection, sciatic nerve irritation, blood clots, re-rupture and incomplete return of strength. These are discussed in detail before surgery.