Hamstring Avulsion (complete tear from pelvis)

[Dra]

Great news rehab again ! Are you still wearing the brace?

For myself I think things are going well , no real pain just discomfort at the incision site today is day 9. Looking forward to next week to have the staples removed.

[Markinjury]

52yo male waterski. Tore the hamstring complex off the pelvic attachment. 2mm of tendon left on pelvis with 2cm gap to the tendon on the muscle. All bones intact. Injury 11days ago. I am using the term, "Avulsion" - the MRI Report said, "hamstring complex". My physio said an Avulsion is when bone is ripped away with tendon. Everything I read is an Avulsion is a complete separation of tendon from bone with bone intact.

On the MRI report the Radiologist recommended NO surgery as there is only 2mm of tendon on the bone to attach to. My Ortho too says NO surgery - just Physio.

We have friends who are doctors and a couple said we should get another opinion. Everything I have read is this complete tear is treated surgically.

Opinions please?

Thank You,

Mark

[Dra]

Mark injury- sorry to hear about you're injury, reading several studies regarding this injury it appears that if you have greater than 2mm retraction and under 50 surgery is highly advised. However reading seval hundred post it appears that most people who has surgery returns to active lifestyle. Get copy of the MRI films and find a surgeon who has some experience with this surgery. If you are in ny I was operated by Andrew Feldman on joint disease. I am 10 days post surgery and doing well. Good luck !

[RehabAgain]

Dra - I never had a brace. Was nervous about this at first so I talked with the doc before surgery and he set me up with one but it was way to uncomfortable. Ended up not using it at all which was good as I could move my knee a bit. Also I got the glue (Dermabond) instead of staples. You can probably be cleared for the pool soon, I had to wait longer because of the glue.

Great news rehab again ! Are you still wearing the brace?

For myself I think things are going well , no real pain just discomfort at the incision site today is day 9. Looking forward to next week to have the staples removed.

[RehabAgain]

Hi Mark,

I was first mis-diagnosed as having 20% of the tendon still attached to the pelvic bone. At this point I was wavering on whether or not to have the surgery. I am not sure how 2mm compares to 20% but 2mm does not seem like much is attached. For a moment I was thinking of going without surgery but was not sure as I am very active. Later when I received the full radiologist report, the docs realized they were missing something on the MRI and it was fully detached. Once I realized this I went ahead with the surgery.

I believe a lot of your decision is going to be based on how active you are and how active you want to remain. Also I find it interesting that the radiologist is recommending treatment options, my understanding is that they are to report findings only? As you know by now this is a rare injury and not many doctors have a great deal of experience with this surgery. I found that a number of them did not want to perform the surgery and recommend that I just "go home and rest". Being active, I targeted a surgeon who also works with a local sports team and he was more than happy to take care of things.

FYI, My MRI reads "Complete rupture of the semitendinosus and conjoined tendon from the right ischial tuberosity with about 1.5cm of retraction. No bone erosion is identified."

Hope that helps.

Mike

52yo male waterski. Tore the hamstring complex off the pelvic attachment. 2mm of tendon left on pelvis with 2cm gap to the tendon on the muscle. All bones intact. Injury 11days ago. I am using the term, "Avulsion" - the MRI Report said, "hamstring complex". My physio said an Avulsion is when bone is ripped away with tendon. Everything I read is an Avulsion is a complete separation of tendon from bone with bone intact.

On the MRI report the Radiologist recommended NO surgery as there is only 2mm of tendon on the bone to attach to. My Ortho too says NO surgery - just Physio.

We have friends who are doctors and a couple said we should get another opinion. Everything I have read is this complete tear is treated surgically.

Opinions please?

Thank You,

Mark

[Dra]

Rehab again thanks for the info getting staples removed in Tuesday , ready for the next step.... One day at a time !

[Markinjury]

DRA. In Washington State. I am 52yo. Fairly active in biking and especially hiking. I won't water ski again nor snow ski.

Rehab. You had 1.5cm separation and I had 2.0cm. Our injuries seem identical pretty much. It seems because there is only 2mm of tendon left on the bone is why they don't want to do surgery. It seems they want to/have to attach the tendon that is retracted to the tendon that is left - the 2mm portion. To what did they reattach your tendon to on your pelvis - bone or tendon?

Has anyone had what I have and NOT had the surgery?

Thank You,

Mark

[RehabAgain]

Mark,

My tendon was re-attached directly to the pelvis bone via 4 "anchors". The rest of the tendon then adheres itself to the bone over time (or at least that is what I was told). The "anchors" stay in and are a material that sort of "becomes bone".

I have been told that surgery is not normally done to attach soft tissue to soft tissue (muscle to tendon or tendon to tendon) but I just heard this from the doctors. It would seem to me that 2mm is so small that it is essentially completely removed? Once again though I am not a doctor (I just play one on the message boards!!) You might want to compare notes with HeelFan? Best of luck.

Mike

[Pia :-)]

Hi Guys,

I've been gone a bit but really enjoyed doing my catch up reading- Rehab - you made me smile with your comment about just playing a doctor here! I am so glad you are doing well!

I am so sorry about the newly injured folks. Mark has some great questions. I'll contribute a few things. The word avulsion in medical-speak simply refers to a tearing off of one body part from another. When talking of hamstring injury, the tearing off of a bit of bone w/ the tendon is not terribly uncommon in the late teenaged person. However, this business of avulsing the tendon from the bone w/o a little chunk of bone and in a person a bit older is very rare. And as we have all found out, most surgeons have not repaired many. In fact it has only been over the last decade that it has been recognized how much benefit there is to repairing the tendon. So - if you are talking to a surgeon who is unfamiliar with the more current research you will find them reluctant to repair it. I lived with my tear a couple of months before surgery and became very clear that for me surgery was a must! I am so glad I have done it.

Now at 6 weeks I am doing well. I swim daily or every other day, walk mostly without crutches and mostly without brace. I am currently back in San Diego at the scene of the initial injury! The car ride/drive was very long! I Started work last week briefly but had to back off d/t way too much pain at night. And that brings me to my question for you all: I am doing well during day with just a background achiness but at night I hurt lots. I am even still using some vicodin. Has anyone else had the same problem with pain? I can't figure out if I am doing too much or if there is any real problem with doing lots and hurting a bit at night?

[Heelfan]

Pia.....you mentioned you lived with the tear for 2 months and it was apparent to you that surgery was a must. Was wondering if you would be willing to email me more on your thought process, symptoms and progress or lack thereof that prompted you to opt for surgery? At this point, I am leaning towards no surgery.