What is the treatment for a partial tear of the proximal biceps femoris?

Treatment for Partial Tear of the Proximal Biceps Femoris

For partial tears of the proximal biceps femoris at the musculotendinous junction, surgical repair is the preferred treatment approach, as it enables return to pre-injury sporting activity with significantly lower recurrence rates and faster recovery compared to conservative management. 1

Initial Assessment and Diagnosis

• MRI is the imaging modality of choice to confirm the diagnosis and characterize the extent of injury, as it reliably identifies musculotendinous junction tears and distinguishes them from proximal tendon avulsions 2
• Ultrasound has lower sensitivity for proximal hamstring injuries (7/12 cases detected) compared to MRI (16/16 cases detected) and should not be relied upon for surgical planning 2
• The biceps femoris long head is the most commonly injured hamstring muscle (124/154 cases), particularly at the proximal musculotendinous junction 2

Definitive Treatment Recommendation

Surgical Management (Strongly Preferred)

Surgical repair of acute proximal biceps femoris musculotendinous junction tears should be performed, based on the highest quality prospective evidence showing superior outcomes 1:

• Return to pre-injury sporting activity: 100% of patients at mean 13.4 ± 5.1 weeks post-surgery 1
• Recurrence rate: Only 1.6% for musculotendinous junction re-injury (1/64 patients) 1
• Significant functional improvements at 3 months post-surgery including:
  • Passive straight-leg raise improved from 24.1° to 72.0° 1
  • Isometric hamstring strength recovered to 84.5-93.9% of contralateral side 1
  • Lower Extremity Functional Scale scores improved from 29.8 to 71.5 1

Conservative Management (Higher Risk Alternative)

Conservative management carries substantial disadvantages 3, 1:

• Prolonged rehabilitation time with delayed return to activity 1
• High risk of recurrence with subsequent injuries 4, 1
• Potential for persistent deformity due to muscle retraction 3
• Decreased strength even after apparent recovery 3

One case report showed functional recovery without surgery, but this patient had persistent cosmetic deformity and hamstring tightness at 1 year 3. Another athlete required three separate injury episodes over 2 months before ultimately requiring surgical repair 4.

Surgical Technique Considerations

• Direct repair of the musculotendinous junction tear should be performed acutely 1
• For intratendinous ruptures, combined end-to-end repair with partial tenodesis to intact adjacent structures (e.g., short head of biceps femoris) can be effective 5
• Early surgical intervention prevents muscle retraction and facilitates better tissue approximation 4, 1

Postoperative Rehabilitation

• Supervised, diligent rehabilitation is essential for optimal outcomes 5
• Return to sporting activity typically occurs at 13-14 weeks post-surgery 1
• High patient satisfaction and functional scores are maintained at 1-2 years follow-up 1

Critical Pitfalls to Avoid

• Do not delay surgical consultation for significant partial tears, as recurrent injury often necessitates eventual surgery anyway with potentially worse outcomes 4
• Do not rely on ultrasound alone for surgical planning in proximal hamstring injuries 2
• Do not assume conservative management is adequate simply because the tear is "partial" - the musculotendinous junction location predicts poor conservative outcomes 1, 2