Are there surgical interventions for a hamstring strain (hamstring muscle injury)?

From the Guidelines

Surgery is rarely needed for a pulled hamstring muscle, and most cases can be managed with conservative treatment. The provided evidence from the American Academy of Orthopaedic Surgeons clinical practice guideline summary 1 focuses on the management of anterior cruciate ligament injuries, but it does not directly address the treatment of pulled hamstring muscles. However, based on general medical knowledge, most hamstring injuries heal with conservative treatment including rest, ice, compression, elevation (RICE), over-the-counter pain medications, and physical therapy.

Key Considerations

• Conservative treatment is the first line of management for pulled hamstring muscles
• Severe cases, such as complete tears or large tears (>2cm retraction), may require surgical intervention
• Surgery is more commonly considered for high-grade tears in athletes or active individuals who need to return to full function quickly
• Recovery after hamstring surgery requires a rehabilitation period of 3-6 months, including progressive strengthening exercises and gradual return to activities

Important Factors

• The decision for surgery should be made after proper evaluation with imaging studies like MRI and consultation with an orthopedic specialist
• Most hamstring injuries (over 90%) respond well to non-surgical management, as indicated by general medical knowledge and not directly stated in the provided evidence 1

Treatment Approach

• Conservative treatment should be the initial approach for managing pulled hamstring muscles
• Surgical intervention should be considered only in severe cases or when conservative treatment fails, and after careful evaluation and consultation with a specialist.

From the Research

Surgical Intervention for Pulled Muscle of Hamstring

• Surgical intervention is considered for certain cases of pulled hamstring muscles, including:
  • Proximal hamstring injuries with 2-tendon injuries and more than 2 cm of retraction 2
  • 3-tendon injuries 2, 3
  • Injuries that do not improve with 6 months of nonoperative management 2
  • Severe 2- or 3-tendon avulsions 4
  • Proximal isolated tendon avulsion with clear retraction in professional athletes 4
• Surgical techniques for proximal hamstring repair include:
  • Endoscopic repair with a double-row suture bridge construct 3
  • Open primary repair 5
  • Augmentation/reconstruction 5
• Studies have shown that surgical treatment of hamstring tendon ruptures can lead to high satisfaction and return to sport rates, especially when performed acutely 4, 6
• The choice of surgical technique and timing of intervention depends on the specific injury pattern, patient presentation, and chronicity of the injury 2, 5, 6
• Postoperative rehabilitation protocols vary, but emphasis on eccentric hamstring strengthening may be beneficial 6