Treatment for Complete Tear of Semimembranosus Tendon at Hip with Retraction
Surgical repair should be performed as early as possible, ideally within 3 weeks of injury, as this is a rare but functionally significant injury that responds poorly to conservative management and deteriorates with delayed treatment. 1, 2
Immediate Diagnostic Confirmation
- Obtain standard hip radiographs first to exclude bony pathology, avulsion fractures, or other structural abnormalities 1, 3
- Proceed with non-contrast MRI of the hip as the definitive imaging study to assess tear location, degree of retraction, and muscle quality 1, 3
- MRI has 33-100% sensitivity and 92-100% specificity for detecting proximal hamstring tears and can identify critical prognostic factors including tendon retraction and fatty degeneration 1, 3
Treatment Algorithm
Acute Tears with Retraction (< 3 weeks from injury)
Early surgical repair is the treatment of choice and should be performed urgently to prevent irreversible muscle changes and optimize functional outcomes. 1, 2
- Surgical repair within 3 weeks produces superior outcomes compared to delayed repair 1, 3
- Early intervention prevents worse outcomes from progressive tendon retraction and fatty degeneration of the semimembranosus muscle 1, 3
- Minimally invasive surgical repair using suture anchors has been successfully reported for proximal semimembranosus ruptures 2
Delayed Presentation (> 4 weeks from injury)
- Surgical repair is still indicated but becomes technically more challenging 2
- Delayed repair typically requires extended mobilization of the retracted muscle belly and potential neurolysis of the sciatic nerve due to scarring 2
- Despite increased technical difficulty, satisfactory results can still be achieved in the majority of cases with delayed repair 2
Critical Pitfalls to Avoid
Do not attempt conservative management for complete tears with retraction, as this injury pattern has proven inadequate in returning patients to their previous activity level. 2
- Avoid delaying surgical repair beyond 3-4 weeks, as tendon retraction and fatty degeneration are poor prognostic factors for functional outcomes and tendon healing 1, 3, 2
- Do not underestimate the severity of this injury—diagnosis is often delayed because clinicians fail to recognize the significant functional loss associated with proximal semimembranosus ruptures 2
- Avoid repeated corticosteroid injections, which have deleterious effects on tendon substance 1, 3
Surgical Technique Considerations
- Suture anchor fixation to the ischial tuberosity is an effective technique for reattachment 2
- Ensure adequate debridement of degenerative tissue at the insertion site to expose fresh bone for healing 4
- Consider checking for concomitant injuries including avulsion fractures at the ischial tuberosity or involvement of other hamstring tendons 5
Postoperative Management
- Activity modification and protected weight-bearing are necessary during the initial healing phase 1, 3
- Physical therapy with eccentric strengthening should be initiated once appropriate healing has occurred 1, 3
- Return to previous activity levels is achievable in the majority of patients when repair is performed early 2, 6