The proximal hamstring is a common location for athletic injuries. A complete, three-tendon (semitendinosus, semimembranosus, long head biceps femoris) tear may occur in sports that involve eccentric contractions of the hamstrings with a rapid hip flexion and knee extension. Surgical treatment of multi-tendon tears with retraction in young active patients has demonstrated significantly better subjective and objective outcomes at short- and mid-term follow-up. A safe surgical approach is via the prone positioning, transverse or longitudinal skin incision, avoidance of the posterior femoral cutaneous nerve, exposure of the ischial tuberosity and proximal hamstring anatomic footprint, avoidance of the sciatic nerve (lateral to tuberosity), secure fixation via two or three double-loaded suture anchors, and meticulous hemostasis and closure. Chronic repair often requires extensive adhesiolysis, sciatic neurolysis, tendon mobilization, and possible allograft augmentation. Postoperative rehabilitation should avoid undue stress on the repair via avoiding hip flexion and knee extension.
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