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.

Hamstring muscles illustration

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.

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