Proximal 1- and 2-Tendon Hamstring Avulsions: Overview and Surgical Technique

Hamstring injuries are common, especially in athletes. They are particularly associated with sports that involve running and jumping, as well as rapid acceleration and deceleration. The spectrum of hamstring injuries spans from minor strains to partial tears to complete avulsions of 1, 2, or all 3 tendons. Severe hamstring injuries in which one or more tendons are completely torn or avulsed are typically characterized by a sudden onset of posterior thigh pain associated with localized tenderness in the upper thigh and some degree of loss of function. When a more serious injury than just a hamstring strain is suspected, magnetic resonance imaging should be done to confirm the diagnosis. Magnetic resonance image provides anatomical detailed information on the hamstrings and their pathology and it can be used to assess the amount of tendon retraction, which is an important feature for preoperative planning in proximal hamstring avulsions. In complete 1- or 2-tendon avulsions of the proximal hamstrings, surgical treatment should be considered the treatment of choice, at least in high level athletes. If, however, nonoperative treatment is chosen, surgery can be a useful option, also later should the conservative treatment fail. In this article, the indications of surgery in proximal 1- or 2-tendon hamstring avulsions are discussed, and the operative technique is presented.