Surgical treatment for hamstring agony makes difference for injury-prone athletes
For most people who suffer hamstring tears, the injury repairs itself within a couple of months. But in some cases it can cause major, long-term agony and require a new kind of surgery, as Nuffield Health explains...
Although a pulled hamstring is a common sports injury and will resolve with time and correct rehabilitation, certain types of tear are much more serious and disabling and, if left untreated, can result in long-term problems.
It is now becoming more common practice to repair complete tears, where the tendons are torn from their attachment to the pelvis, but it is less obvious what to do when the tendon attachment is partially torn and inflamed.
Over the last few years, consultant trauma and orthopaedic surgeon at Nuffield Health Cardiff and Vale Hospitals, Chris Wilson, having had good results from repairing complete tears, has operated on a number of patients with partially torn and inflamed hamstring muscles and the results have been most encouraging.
The attachment of the three powerful muscle groups to the pelvis is important in stabilising the body in motion.
In athletes this area is prone to injury owing to the forces exerted by these muscles – often several times body weight in changing directions in sporting activities.
The hamstring group of muscles contract to extend the hip and flex the knee. It is the forceful extension of the hip and simultaneous extension of the knee, which causes the hamstring tears and even avulsion.
Hamstring avulsions, where the hamstring tendon tears away from the pelvis, can cause significant problems.
They commonly occur during sports involving sudden, extreme or unbalanced contracture of powerful muscles, such as sprinting, hurdling, rugby and martial arts and, classically, water skiing.
Partial tears may also occur in people in their 40s and 50s as a result of age-related weakening of the tendon attachment.
Left untreated, these can be incredibly painful and there is a risk that they will eventually snap.
Mr Wilson explains: “Patients with hamstring muscles that are partially torn at the top where they attach to the pelvis come to me with severe buttock pain and inflammation.
“They are no longer able to run and even have trouble sitting comfortably. It is still an unusual idea to carry out a surgical repair for partial tears, whereas if the hamstring muscles
have completely torn away it is generally becoming accepted practice that surgery is the appropriate treatment.
“In selected cases, where non-surgical treatment has failed, surgical treatment of these partial tears can be very successful in returning people to a full level of activity and reducing pain.” Mr Wilson said: “To begin with an MRI scan is done to confirm the diagnosis and to locate exactly where the tear is.
“Then the operation is discussed with the patient. The operation can take up to two hours and is performed under general anaesthetic with the patient lying face down.
“A 10cm incision is made along the crease line under the buttock. From there, the sciatic nerve is located to ensure it is left undisturbed.
“The injury means that the hamstring tendon has become inflamed and during the course of the surgery, the fluid and dead removed.
“The area where the hamstring is going to be re-attached is prepared and tiny titanium anchors, which look like small darts, are inserted into the bone and the hamstring tendon is stitched onto these.
“The whole area is closed using absorbable stitches that dissolve within about four weeks.
“The patient remains in hospital overnight and then goes home on crutches the next day.
“For the first few weeks they are advised to take care when sitting down or bending.
“They have to learn to sit down using their non-operated side to take the pressure off the buttock that has had surgery.
“After a month, they no longer need crutches and can start physiotherapy. After three months, more vigorous physical exercise can usually commence.“ tissue
■ For more information visit www.nuffieldhealth.com/ consultants/mr-chris-wilson are