Our Summary

This research paper discusses different types of injuries to the hamstring, which is a group of muscles located at the back of the thigh. These injuries can range from chronic (long-lasting) damage to the tendon (tendinosis), sudden pulls or tears (strains), partial tearing away of the tendon from the bone (avulsions), or a complete rupture of all three tendons in the hamstring.

The paper suggests various treatment options depending on the severity and type of injury. For less severe injuries like chronic tendinosis and minor tears, non-surgical methods like changing physical activity, taking anti-inflammatory medication, and undergoing physical therapy are recommended. Newer treatments like injecting platelet-rich plasma (a component of your blood that helps healing), using corticosteroids (a type of anti-inflammatory drug), dry needling (a technique to release muscle tension), and shock wave therapy (using sound waves to stimulate healing) can also be beneficial.

However, for more serious injuries such as complete avulsions, when at least two tendons are injured with more than 2 cm of separation, especially in young, active individuals, or for injuries that have not improved with non-surgical treatments, surgery may be needed. The surgical treatments can involve directly repairing the injury in an open or endoscopic (using a camera) procedure, or strengthening/rebuilding the area.

FAQs

  1. What are the nonoperative treatments for chronic insertional tendinosis and low-grade tears?
  2. When is surgical intervention indicated for hamstring injuries?
  3. What are the types of surgical management for proximal hamstring injuries?

Doctor’s Tip

A helpful tip a doctor might tell a patient about tendon repair is to follow the prescribed rehabilitation program diligently. This typically involves a combination of physical therapy exercises, stretching, and strength training to help improve flexibility and strength in the affected area. It is important to not rush the recovery process and to listen to your body, gradually increasing activity levels as advised by your healthcare provider. Additionally, maintaining a healthy diet and staying hydrated can support the healing process. Regular follow-up appointments with your doctor are also important to monitor progress and make any necessary adjustments to your treatment plan.

Suitable For

Patients who are typically recommended tendon repair include those with complete proximal avulsions, partial avulsions with at least 2 tendons injured with more than 2 cm of retraction in young, active patients, and partial avulsion injuries or chronic tendinosis that have failed nonoperative management. These patients may present with chronic tendinosis, acute strain, partial tendinous avulsions, or complete 3-tendon rupture of the hamstring tendon. Nonoperative management options may be considered for chronic insertional tendinosis and low-grade tears, but surgical intervention may be necessary for more severe injuries or cases that do not respond to conservative treatments.

Timeline

Before tendon repair:

  • The patient may have been experiencing chronic pain, swelling, and weakness in the affected tendon.
  • Nonoperative treatments such as activity modification, anti-inflammatories, and physical therapy may have been tried without success.
  • The patient may have undergone imaging studies such as MRI to assess the extent of the tendon injury.
  • Injections of platelet-rich plasma, corticosteroids, or other therapies may have been considered as alternative treatments.

After tendon repair:

  • The patient undergoes surgery to repair the damaged tendon, either through open primary repair, endoscopic primary repair, or augmentation/reconstruction.
  • Post-operative care includes immobilization, physical therapy, and gradual return to activity.
  • The patient may experience pain, swelling, and stiffness in the immediate post-operative period.
  • Over time, the patient should see improvement in strength, range of motion, and function of the repaired tendon.
  • Full recovery can take several months, with a gradual return to normal activities and sports.

What to Ask Your Doctor

  1. What is the extent of my tendon injury and what are my treatment options?
  2. How long will it take for me to recover from tendon repair surgery?
  3. What are the potential risks and complications associated with tendon repair surgery?
  4. Will I need physical therapy after surgery, and if so, how long will it last?
  5. What type of rehabilitation program will I need to follow post-surgery?
  6. How soon can I return to my normal activities and sports after tendon repair surgery?
  7. Will I need any additional treatments or therapies to help with my recovery?
  8. What can I do to prevent future tendon injuries in the same area?
  9. Are there any lifestyle changes I should make to support my tendon repair and overall recovery?
  10. How often should I follow up with you after the surgery for monitoring my progress?

Reference

Authors: Fletcher AN, Cheah JW, Nho SJ, Mather RC 3rd. Journal: Clin Sports Med. 2021 Apr;40(2):339-361. doi: 10.1016/j.csm.2021.01.003. Epub 2021 Feb 10. PMID: 33673891