Hamstring muscle injuries are some of the most common injuries among athletes. A rare, although increasingly recognized, hamstring injury is an avulsion of the tendon. In this Ask Dr. Geier column, I answer the question of a reader who suffered a hamstring tendon tear and wonders if she needs surgery.

Jan writes:
Hi Dr. Geier,
I fell and have an avulsion of the common hamstring tendon from the ischium. Is this an injury that requires surgery? The injury was confirmed by an MRI.

Thanks for the question, Jan! Generally these injuries often require surgery. While I can’t offer you specific medical advice, I do hope you recover well! Let’s discuss this injury and how it differs from a hamstring muscle strain.

Mechanism of injury

Unlike a muscle strain with stretching or tearing of some of the muscle fibers, an avulsion or rupture of the hamstring tendon can be a more serious injury. It most often occurs at the hip/pelvis, where the common hamstring origin attaches at the issue tuberosity (sit bone). The biceps femoris, semimembranosus and semitendinosus attach to this bone by a common tendon.

Treatment options

Several studies have shown that nonoperative treatment that usually works well for hamstring muscle strains might have less than optimal results for tendon avulsions. Persistent pain, weakness and functional limitation often persist months or years later.

Therefore many sports medicine orthopedic surgeons have tried to make the diagnosis sooner. X-rays can show if the tendon has pulled a small piece of bone off the ischial tuberosity. An MRI can reveal a complete tendon avulsion or rupture off of the bone and how far it has retracted from the bone.

Surgery for a hamstring tendon tear

Surgeons are more commonly repairing hamstring tendon avulsions early after the injury. Concern exists that a more extensive surgery could be required if the diagnosis is made months after the injury and the tendon retracts many centimeters from the bone. If caught early, the surgeon can reattach the tendon with stitches and/or suture anchors. If a large piece of bone comes off with the tendon, the surgeon might fix it with one or more screws.

Also read:
Ask Dr. Geier: MCL injuries
Ask Dr. Geier: Can PRP help an athlete recover faster from a hamstring injury?

Recovery from surgery and return to sports or exercise can take 6 to 12 months. It’s a significant operation. Many orthopedic surgeons, though, feel that surgical repair of hamstring tendon injuries might have better outcomes than nonoperative treatment.

Recommended Products and Resources
Click here to go to Dr. David Geier’s Amazon Influencer store!
Due to a large number of questions I have received over the years asking about products for health, injuries, performance, and other areas of sports, exercise, work and life, I have created an Amazon Influencer page. While this information and these products are not intended to treat any specific injury or illness you have, they are products I use personally, have used or have tried, or I have recommended to others. THE SITE MAY OFFER HEALTH, FITNESS, NUTRITIONAL AND OTHER SUCH INFORMATION, BUT SUCH INFORMATION IS DESIGNED FOR EDUCATIONAL AND INFORMATIONAL PURPOSES ONLY. THE CONTENT DOES NOT AND IS NOT INTENDED TO CONVEY MEDICAL ADVICE AND DOES NOT CONSTITUTE THE PRACTICE OF MEDICINE. YOU SHOULD NOT RELY ON THIS INFORMATION AS A SUBSTITUTE FOR, NOR DOES IT REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. THE SITE IS NOT RESPONSIBLE FOR ANY ACTIONS OR INACTION ON A USER’S PART BASED ON THE INFORMATION THAT IS PRESENTED ON THE SITE. Please note that as an Amazon Associate I earn from qualifying purchases.