Surgical Technique: Open Proximal Hamstring Repair

The proximal hamstring is a common location for athletic injuries. A complete, three-tendon (semitendinosus, semimembranosus, and long head of the biceps femoris) tear may occur in sports that involve eccentric contractions of the hamstrings with rapid hip flexion and knee extension. Surgical treatment of multi-tendon tears with retraction in active patients has demonstrated significantly better subjective and objective outcomes at shortand mid-term follow-up. A safe surgical approach is performed via prone positioning, transverse or longitudinal skin incision at the gluteal fold, avoidance of the posterior femoral cutaneous and sciatic nerves, exposure of the ischial tuberosity and proximal hamstring anatomic footprint, secure anchor fixation, appropriate hemostasis, and meticulous closure. Chronic repair often requires extensive lysis of adhesions, sciatic neurolysis, tendon mobilization, and possibly allograft augmentation. Postoperative rehabilitation should initially avoid undue stress on the repair from hip flexion and knee extension to allow adequate healing before advancing mobilization and strength training.