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Hamstring Avulsion (complete tear from pelvis)

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  • Hamstring Avulsion (complete tear from pelvis)

    Hi there,
    Has anyone had an avulsion of the hamstring? I have been told by GP that is will need to be surgically repaired, but cannot get in to see the surgeon for 8 weeks. If anyone has experience with a hamstring repair, I would love to know about the op, how long after the injury and the rehab.
    Look forward to hearing

  • #2
    Hi, sorry about your injury,

    I just read an article in J Am Acad Orthop Surg, Vol 15, No 6, June 2007, 350-355. If you can get your hands on the article, it gives a great review of all of the pertinent literature about surgical repair of proximal hamstring avulsions (tearing the hamstring tendons off of the sit-bone). Here is the abstract:

    Hamstring strain is common in athletes, and both diagnosis and surgical treatment of this injury are becoming more common. Nonsurgical treatment of complete ruptures has resulted in complications such as muscle weakness and sciatic neuralgia. Surgical treatment recently has been advocated to repair the complete rupture of the hamstring tendons from the ischial tuberosity. Surgical repair involves a transverse incision in the gluteal crease, protection of the sciatic nerve, mobilization of the ruptured tendons, and repair to the ischial tuberosity with the use of suture anchors. Reports in the literature of surgical treatment of proximal hamstring rupture are few, and most series have had a relatively small number of patients. Surgical repair results project 58% to 85% rate of return to function and sports activity, near normal strength, and decreased pain.

    If you have a complete avulsion(tear) that has retracted 1 to 2 cm, then most of these are going to surgery. If the tear has not retracted more than that, conservative measures tend to be the better way. If I remember correctly, the sooner the tendon is repaired, the better but some of the cases were out months to years and still had good outcomes.

    If you want a copy of the article, I could send it to you.

    So, basically, it depends on the amount of retraction of the tendons (need to have an MRI to make that measurement.)

    Good Luck!

    Comment


    • #3
      Hi,
      I have rehabed a rugby union player back from a surgical repair of a complete proximal avulsion and he returned after 6 months to play international rugby. Conservative management may not return the player to the pre-injury performance levels however. There are a few case studies in the literature, mostly waterskiing injuries. Considering the level of activity required post injury would nfluence which management plan.

      Comment


      • #4
        Recently had complete avulsion repair surgery

        Lise -- I suffered a complete hamstring avulsion (from the ischial tuberosity) on Sept. 9th and had surgery to repair the avulsion on Oct. 3rd. Surgeon said that the hamstring/tendons had retracted only about 1 cm in that time. (From what I read, more significant retraction occurs if repair surgery is delayed in terms of months.) Incision was in the line between the back of butt and top of back of leg, and only about 1 inch wide. He anchored the hamstring tendons back to the pelvic bone with 3 anchors. From what I read, the only option besides surgery for this injury is, essentially, to do nothing and hope that the scar tissue that builds up around the tendon can bridge and (sort of) re-anchor the muscle back to the hip bone. But a lot of complications can arise and scar tissue is notoriously unpredictable. In that case, you cannot ever expect a return to 100% strength in the muscle.

        My doctor has prescribed -- 6 weeks on crutches post-surgery, then 3-5 months (perhaps more) of physical therapy to restrengthen the hamstring muscle. He said that, by Spring, I will be "rocking and rolling" and can return to skiing, hockey and all other sports. He said I should expect to return to 100% (or near 100%) strength and mobility.

        Just wanted to let you know about my experience and what I've learned to date in dealing with this injury, as well as going through the repair surgery.

        Best of luck with the recovery.

        Comment


        • #5
          Hey, I suffered an avulsion 3 years ago and I still experience alot of pain when I play sports. I was in 8th grade when I had the injury and they decided to treat it conservatively, but after no progress was made I had the surgery about 10 months later. My surgeon reattached the bone via a screw and reattached the tendon to the bone with staples. The screw has since been removed, and apparently everything "has healed fine". The only problem being that tendon doesn't repair with tendon tissue, but instead scar tissue. My doctor informed me that this is probably as good as it is going to get for me. If you have this injury, I urge you to have the surgery done ASAP to prevent migration of the tendon and the bone, which will result in a less successful recovery. I still experience pain even when walking or sitting, especially after intense activity. I have extreme tightness in my injured leg, and it is painful to run. Because of this injury I haven't (and possibly never will) had a healthy day of high school sports.

          This injury has been an extremely depressing experience for me, and I wish those of you that have also had it the best of luck.

          Beau

          Comment


          • #6
            Complete Hamstring Avulsion and surgry to repair

            I am posting my experience to date so that others may benefit. I completely tore my right hamstring on 9-26-07 [Wed nite around 9:30PM] while playing men's ice hockey. I am 50-yrs old. I ended up in an awkward position of going down into a full-splits position that I couldn't get out of ... my weight and momentum are what tore the hamstrings; I was not hit by another player - just a fluke accident. In fact, I remember thinking as it was happening - "I don't do these anymore" ... felt like a giant rubberband vibrating violently in the upper-back-part-of-my-thigh .... then it just gave way .... I heard no pop. But I went down in pain when it tore off ... I asked a few of the players to try and stand me up .... but I could not stand the pain. I had them slowly drag me off the ice .... so they could play as I waited for an ambulance. Went to ER .... got a heavy dose of pain meds, given crutches and sent home. I literally did not move [used a pee bottle] from my couch for 2 1/2 days [got off couch Sat. aft for 1st time] . Huge bruise - very purple and large show-up by Sat -- covered the back of my thigh. So injury happened on a Wed nite ... following Tues AM finally went to Doc. He said I a severe hamstring injury .... like what water-skiers often get .. and referred me to a Sports Doc-specialst. He did an Ultrasound -- but said injury was too deep ... but also felt it was severe. He took X-ray and ... showed no bone fragments. Had an MRI following Wed [now 2-weeks post op] then Docs eval of MRI by end of 2nd week-post-injury. He said it showed a complete avulsion of the hamstrings w/ about a 5 to 6 inch retraction of the muscle. He recomended that I talk to a surgeon to do repair. It should be noted that this was 2 weeks post-injury; I was actually feeling pretty good and no longer using crutches/walking up and down stairs like normal. When I was told it was a complete tear I was surprised, shocked and sad all at once. I asked how could that be .... I was feeling pretty good? Doc told me ... not unusual because there was actually no more significant healing going on because I had already been thru the trauma of the injury ... and since it was completely tore off ... there was no more healing to do. He set-up appt w/surgeon - Dr. Lee Kaplan - from Univ. of Madison UW-Hospital; who also specializes in these injuries and had just performed the same type of repair operation on UW Football team's #1 receiver - Luke Swan. Luke had his surgery 9 days [Oct. 10th] prior to mine. I am now 16 days post-op [surgery was 10-19]; I actually feel great - no pain from surgery and no pain post op for which I am very grateful . I have been told that my rehab to get back to ice hockey is approx. 6 months - but of course this is an individual thing and I have to realize that I am 50 and not 20. Tommie Harris of the Chicago Bears in the NFL had his surgery in Dec. 2006 and was playing again for them this year. I play recreational men's ice hockey at least 4+ times a week and remain positive about my recovery. I would be more than happy to answer questions about anything I can help you with.

            Comment


            • #7
              Wanted to offer you something I've learned that might help you. I was told today that I need to get hamstring surgery to repair a torn hamstring and that the hamstring has also attached itself to the sciatic nerve which runs down the leg, and so they will seperate this attachment between the hamstring and the nerve. The pain you decribe is exactly what I feel. Maybe you can talk to another doctor about this - it doesn't sound like your pain will ever go away if the nerve is involved. If you want to do research, it's called "hamstring syndrome". All the studies I've read show very high success rates for people with hamstring surgeries returning to competetive sports, so it seems odd that you are still in pain. Good Luck!


              Originally posted by beau_zo_brehm
              Hey, I suffered an avulsion 3 years ago and I still experience alot of pain when I play sports. I was in 8th grade when I had the injury and they decided to treat it conservatively, but after no progress was made I had the surgery about 10 months later. My surgeon reattached the bone via a screw and reattached the tendon to the bone with staples. The screw has since been removed, and apparently everything "has healed fine". The only problem being that tendon doesn't repair with tendon tissue, but instead scar tissue. My doctor informed me that this is probably as good as it is going to get for me. If you have this injury, I urge you to have the surgery done ASAP to prevent migration of the tendon and the bone, which will result in a less successful recovery. I still experience pain even when walking or sitting, especially after intense activity. I have extreme tightness in my injured leg, and it is painful to run. Because of this injury I haven't (and possibly never will) had a healthy day of high school sports.

              This injury has been an extremely depressing experience for me, and I wish those of you that have also had it the best of luck.

              Beau

              Comment


              • #8
                Now 8-weeks post op - feeling good - and anxious

                I am now 8 weeks post op, feeling good and anxious. Meet with my surgeon and PT today [12-13-07]; both want to stay with a conservative course of rehab. I have been in the pool for almost 3-weeks doing warm-pool-hydro therapy for approx. 40-to-45 minutes up to 6 x per week [recommended 4x per week minimum] I have been on a bike for 1-week - PT is for 10-to-15 minutes 4 to 5 x per week on stationary bike. PT in both the pool and bike is not to push yourself to cause pain - it should be pain-free and for me it is. And, I have not experienced pain from the repair - however, I do have a "sense" of where it has been re-attached. I have additional leg, abdominal and lower back exercises that are part of my PT routine that I also need to do a minimum of 4x per week. I wore a brace for 5-weeks post op. I no longer wear the brace unless I have to shovel snow. I hope to return to skating and ice hockey sometime in Feb. 2008. At least at this point I get to exercise - for 3-weeks post op I did basically nothing except for a handful of isometric exercises.

                Comment


                • #9
                  I too need help!

                  Can anyone help me?

                  I was injured 2 years ago in a waterski accident. I was wrongly diagnosed and told that there was nothing to be done. I recently further injured the muscle. I had a new MRI and the specialist said that the elasticity was so far gone that surgery was impossible. I am undergoing rehabilitation for the new injury with almost no improvement. Is there any sort of replacement surgery available? I am really willing to try anything! Thank you


                  Originally posted by Lise
                  Hi there,
                  Has anyone had an avulsion of the hamstring? I have been told by GP that is will need to be surgically repaired, but cannot get in to see the surgeon for 8 weeks. If anyone has experience with a hamstring repair, I would love to know about the op, how long after the injury and the rehab.
                  Look forward to hearing

                  Comment


                  • #10
                    I am a new member and not very good with computers! I might be posting this twice! I had a complete avulsion of the hamstring 2 years ago. I was, unfortunately, misdiagnosed and was told nothing could be done. A few weeks ago I further injured my leg. A new MRI was done and the specialist said that the old injury had caused so much scar tissue and had so little elasticity that there was nothing to be done. I am undergoing rehab for the new injury with little success. I would love to know if there is any hope of a replacement or artificial transplant? Does anyone have advice? Thank you!

                    Comment


                    • #11
                      My son is 14 and he just had surgery yesterday to repair a hamstring avulsion. We're now struggling with the braces. What have others done post-op to immoblize the hamstring - braces? bedrest? Thanks in advance!

                      Comment


                      • #12
                        6-months post surgery to repair hamstring avulsion

                        Hi.

                        It has now been 6-months post surgery to the day since I had my right hamstring repaired. I have returned to playing ice hockey again - and almost at the level I was at prior to my injury (I am at better than 90%). I expect to be at or close to 100% within the next month or 2.

                        I have been very pleased with the rehab and can't say enough positive things about working closely with my surgeon and physical therapist. I started skating but with restrictions about mid-Feb (2008); I was under strict guidelines not to push-off hard and absolutely no burst accelerations. No slapshots or to try and do difficult shots or manuveurs.

                        Over the next 2 months I have continued to skate and play ice hockey approximately 4 times per week. I also continued work in the gym/rehab center to strengthen my repaired hamstring. I have yet to experience any significant pain or discomfort from the repaired hamstring. I have been very pleased with the level of intensity of exercising and skating that I have been able to perform.

                        The only thing I have yet to do is to shoot a hard slapshot; although I feel that I would have no problem doing it - I just have no real desire to. I skate with full confidence and do not think about my injury when I skate; I am very comfortable skating and playing again and have no problems with skating/turning in any direction - fowards or backwards.

                        My final stages (the next month) of rehab is for incorporating harder skating and burst acceleration, and sustaining higher speeds. I have been able to achieve burst acceleration and harder skating with no problem; and have successfully skated after and beat other players for the puck and skated on breakaways.

                        I hope this helps keep others feeling positive about working hard on their rehab for a hamstring avulsion. I have also heard that Luke Swan (football injury) has done well with his rehab too. I was told that my recovery-rehab would be 4-to-6 months back on the ice and playing again; and that is what it has been.

                        Comment


                        • #13
                          Partial rupture of hamstring

                          Pedro99 and others,

                          I had my (partial) rupture of April 3rd. It was very painful. I was alone and out of town, and all I managed to do was climb into bed and collapse for the night. Next day I was able to browse for answers on the Net, and I was afriad that it was a rupture based on what I saw. I decided to visit with an ortopedist in Aventura Hospital in FL (that is where I was), who was really no good and misdiagnosed it as not a rupture. He asl owanted to start PT right away, a bad move as i understand now. Back home, I visited a specialist in Sports Medicine, M. Krauss, who did a superb job at examining the injury and correctly diagnosing it. The MRI later confirmed: two gone, one still attached.

                          He referred me to to P. Sallay, a surgeon in Indy who is one of the experts in this type of surgery. I was operated exactly two weeks after the injury happened. It was done with Titanium anchors and sutures to the muscle, which is pulled toward the anchors. Up to now, am extremely happy with the treatment. I am trying to stay in bed as much as possilble. When up, I use crutches and a harness. I do feel considerable stiffness in the lower part of the hamstring. It is hard to be confined to bed, but I am afraid of damaging the repair or hamstring by moving too much. It would be great if Pedro99 could offer some specific advice on the first week to 10 days after surgery. Did you feel some stiffness of the hamstring as well? How long were you immobilized?

                          My sports are yoga, tennis and running. In the future, I will comment on my performance here so people can have another view from a patient. Pedro's has been helpful to me. For those academically inclined, there are papers describing the surgery and its results. It was reassuring to see that my doctor had published his experience with surgery in academic journals.

                          Comment


                          • #14
                            the brace sucks

                            I just spent 45 minutes with a reply and got logged out and lost it - "dohhh"

                            I'm a 39 year old male and I had a near complete avulsion of the semitendinosus hamstring while waterskiing on June 9th, 2008. It was reattached on July 3rd - 24 days post injury. It was 11cm avulsed, so a second incision down the leg was needed (a few inches long), in addition to the typical higher incision following the buttocks.

                            The post surgical pain has been minimal - especially compaired to the initial injury. I only needed 3 pain pills and I am 8 days post surgery. Discomfort is more in numbness and limitaions, and the brace itself. Knee brace set at 60 degress.

                            The one thing that I wish I was better prepared to deal with, is the thing that no one wants to talk about: evacuation procedures. First of all, the incision along the crease of the buttocks is very close and vulberable to the evacuation area - know what I mean? Fecal matter in a wound could be awful! Trying not to extend the injured leg or put any pressure on it, while trying to sit on the toilet, is next to impossible, and the pain is nearly unbearable. The entire process is awkward, messy, painful, and unavoidable.

                            I got a raised toilet seat from physical therapy before I had surgery, but realized that it was going to be even less stable and didn't allow me to sit and evacuate on just the one cheek, so I never used it. Best suggestion I have is - just do it! Don't wait until you are constipated (pain pills will constipate, so get some mild laxatives). Also, wiping and cleaning up is easier once you are standing - have plenty of anti bacterial baby wipes on hand, and plan your showers for afterward.

                            I am completely off my feet until Monday - staples and sutures removed 11 days post op, and we'll see what the doc says then. No weight bearing for a couple of more weeks at least, I am expecting. Six weeks post op until I can start physical thereapy is what he said before. I would love to have the brace off as soon as possible, but wonder what the risk is to injuring the repair.

                            Quick recovery everyone,

                            Vince from Colorado

                            Comment


                            • #15
                              I just had surgery on Thursday July 31st. I'm in a brace and have been restricted not to put any weight on my leg. I?m spending most of my time trying to get comfortable in bed. Today, I took my bandages off and have about a 12 inch scar. I didn't think that it would be quite that long. Post op pain as been moderate to severe, controlled by about 8 500mg vicodin a day. I have been eating extremely light because with the pain and the brace I don't really care to tackle the toilet. Purchased a rubber ring and hope that it will help when the need arises. I retracted one of the hamstrings 4 months ago and finally, after seeing 8 physicians, one felt he was up to the task at hand. The pain I experience prior to the surgery was disabling. I fortunately have my own business, but could only work about 5 hours with a few Vicodins on board. I know what you all have been through and wish you all the best. Still not sure why I have such a long scar.

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