From the Research
Surgery for a hamstring tendon rupture is typically performed within 2-4 weeks of injury for optimal outcomes, with early surgical intervention recommended for complete tears, especially in athletes or physically active individuals, as it allows for better tendon reattachment before significant retraction and scarring occur. This approach is supported by the most recent and highest quality study, which found that surgical treatment of hamstring tendon ruptures leads to high satisfaction and return to sport rates, with better results after acute surgical repair, especially in complete avulsions 1. The study also notes that athletes with hamstring tendon ruptures should be treated more aggressively with operative methods.
Key Considerations
- Early surgical intervention (within 2-4 weeks) is recommended for complete tears, especially in athletes or physically active individuals, to allow for better tendon reattachment before significant retraction and scarring occur.
- Surgical treatment is generally indicated for complete tears with more than 2 cm of retraction, tears involving more than 50% of the tendon thickness, or when there is significant functional deficit.
- Delayed surgery (beyond 4 weeks) is still possible but may result in more complicated procedures and potentially less favorable outcomes due to muscle atrophy, tendon retraction, and scar tissue formation.
- The surgical approach involves reattaching the torn tendon to its anatomical insertion using suture anchors or bone tunnels.
- Following surgery, patients typically undergo a structured rehabilitation program lasting 3-6 months, beginning with protected weight-bearing and gradually progressing to strengthening exercises and sport-specific activities.
Decision-Making
The decision for surgical timing should be individualized based on the patient's age, activity level, functional demands, and the specific characteristics of the tear as determined by clinical examination and imaging studies. As noted in the study, early surgical repair leads to better functional results with lower complication rates, especially in complete avulsions 1. Additionally, the study found that both complete and partial hamstring tendon ruptures have better results after acute surgical repair, when compared to cases treated surgically later 1.
Rehabilitation
The rehabilitation program, including avoidance of postoperative bracing, appears effective for total proximal hamstring ruptures, with one study reporting only one re-rupture in over 200 patients with surgical repair for total proximal hamstring tendon rupture 2. The rehabilitation program typically lasts 3-6 months, beginning with protected weight-bearing and gradually progressing to strengthening exercises and sport-specific activities.
Outcomes
The outcomes of surgical treatment of hamstring ruptures are generally good, with high satisfaction rates and return to sport rates, especially in athletes or physically active individuals who undergo early surgical intervention 1. As noted in the study, surgical treatment of hamstring tendon ruptures leads to high satisfaction and return to sport rates, with better results after acute surgical repair, especially in complete avulsions 1.