Surgery for Chronic High (Proximal) Hamstring Tendinopathy

The surgical literature has reported good to excellent outcomes in patients with chronic high (proximal) hamstring tendinopathy, who have failed to find relief with non-invasive or minimally invasive management.¹Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.^,2Benazzo F, Marullo M, Zanon G, Indino C, Pelillo F. Surgical management of chronic proximal hamstring tendinopathy in athletes: a 2 to 11 years of follow-up. J orthop Traumatol 2013;14:83-9. Surgical treatment can involve anything from debridement of the diseased tendon to complete tenotomy (cutting of the tendon) and reattachment.¹Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.

• Debridement involves the removal of diseased or damaged tissue, with the hopes that new, healthier tissue will grow in its place. The same technology used in tenotomy may allow this procedure to be performed in a minimally invasive fashion in certain patients.³Pourcho AM, Hall MM. Percutaneous Ultrasonic Fasciotomy for Refractory Plantar Fasciopathy After Failure of a Partial Endoscopic Release Procedure. PM R. 2015 Apr 7. pii: S1934-1482(15)00182-3^,4Barnes DE, Beckley JM, Smith J. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elbow Surg. 2015 Jan;24(1):67-73. doi: 10.1016/j.jse.2014.07.017. Epub 2014 Oct 8. PubMed PMID: 25306494.^,5Patel MM. A novel treatment for refractory plantar fasciitis. Am J Orthop (Belle Mead NJ). 2015 Mar;44(3):107-10. PubMed PMID: 25750942. Interested patients should consult a qualified practitioner.

Complete tenotomy, sometimes called a tendon release, involves cutting the tendon and reattaching it to the bone.¹Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34. If the sciatic nerve has become painfully trapped in scar tissue as a result of the tendinopathy, the surgeon may free it during this surgery (neurolysis). ⁶Askling C, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics. Am J Sports Med 2007;35:1716-24. Complete tenotomy surgery requires a long recovery period and should be reserved for patients who have exhausted other options.

Surgical treatment for chronic hamstring tendinopathy is elective surgery, meaning it is the patient’s choice. As always, it is important for doctors and patients to work together to individualize treatments based on the individual’s lifestyle, injury, and sport.