Problems After Surgery (Complications)
It is important when considering surgical repair of proximal hamstring injuries to not only consider the benefits but the risks as well. There are complications associated with proximal hamstring ruptures even prior to surgical treatment, related to the type of injury and they can be early or delayed. The early complications most commonly involve a neuropraxia (injury to the sciatic nerve) as a result of a stretch injury. Depending on the mechanism and force of the injury the sciatic nerve can be damaged leading to burning symptoms radiating down the leg and weakness of the foot. This is critical to determine during the initial examination to document and ensure that there is no additional injury at the time of surgery. Fortunately however, a neuropraxia injury most commonly goes over time, despite being troubling initially. The problem can last several weeks. Delayed problems from nonoperative treatment of proximal hamstring ruptures have been include weakness in bending the knee and hip extension weakness, difficulty sitting, hamstring deformity, and the potential development of symptoms associated with scar tissue to the sciatic nerve. Pain may worsen with stretching and during exercises such as sprinting, hurdling, kicking.
Surgical for proximal hamstring ruptures also has its inherent risks. Superficial as well as deep wound infections can occur similar to any other surgeries, however, the location of the incision can potentially increase this risk due to the proximity of the incision to urination and bowel movements. Additionally there are three main nervous structures at risk and they are the posterior femoral cutaneous (PFC), inferior gluteal nerve, and sciatic nerves. The PFC nerve runs down the back of the thigh and provides sensation to the back surface of the thigh and leg as well as to the skin of the groin. It can be injured during the surgical approach for repair if it is not protected. The inferior gluteal nerve is the principal extensor as it allows the gluteus maximus (butt muscle) to function. It can be injured with retraction of the gluteus during the surgical approach.
The sciatic nerve is the longest and widest single nerve in the human body. The sciatic provides sensation of the skin of the leg and makes the muscles of the back of the thigh calf and foot work. The nerve is close to the ischial tuberosity as can be seen in the figures above.
Other potential complications associated with proximal hamstring repair include rerupture, weakness, and sitting pain. In the number of reports on hamstring repair, reruptures are rare. In one study, three of 41 patients were found to have failure of surgical repair. Several studies have tested postoperative hamstring strength after repair. One study found that mean postoperative strength was 84% as compared to the other side; however other studies have shown a return of strength ranging from 60-90% following repair.
In summary, proximal hamstring ruptures can be treated endoscopically. This allows early treatment with surgical repair and a faster recovery as a result of the limited scarring and incision that are necessary. With proper treatment, good functional results can be achieved in most patients. It is important to realize that some patients may not be candidates for this procedure as a result of several factors including a larger tear, prior surgery and many other factors. It is important to discuss these things with your doctor.