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  • Q&A with Australian Health Practitioners

    Complete hamstring avulsion?

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    Orthopaedics
    Following a heavy fall, my MRI has revealed "complete tear of hamstring muscle complex origin tendons from ischial tuberosity with significant reduction." I was able to walk (painfully!) straight after and 2 weeks later can flex my knee behind me while standing. Is there a chance of false positive from MRI?
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    • Dr Simon Zilko
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  • Dr Simon Zilko

    Orthopaedic Surgeon

    Dr Simon Zilko - Foot & Ankle Orthopaedic Surgeon Dr Simon Zilko is a locally and internationally trained consultant orthopaedic surgeon who specialises in all … View Profile

    Thanks for your question. I assume that the word 'reduction' is meant to be 'retraction' from your MRI report. Complete hamstring avulsions (ie all three tendons have come off the ischial tuberosity) often result in some retraction down the leg. MRI is the best study and is very accurate for this injury, so unfortunately it's unlikely to be a false positive (remember that other muscles other than your hamstrings assist in knee flexion).

    Whilst I don't operate on these injuries any more, I have done extensive research on proximal hamstring avulsions. Patients with incomplete proximal tears with no retraction often do well with conservative treatment, but complete avulsions with retraction do best with surgery to repair the tendons to their bony origin. Injuries operated on within 3 months do better than chronic injuries repaired late.

    Because this operation is not commonly done by many orthopaedic surgeons, it's important to find someone who is very familiar with this injury. David Wood in Sydney and Peter Annear in Perth are two surgeons who have done more of these operations than most orthopaedic surgeons in the world.

    A Novel Technique for Proximal Hamstring Tendon Repair. Blakeney WG, Zilko SR, Chiri W, Annear P. Advances in Orthopedic Surgery, Vol 2014, Article ID 891875. doi:10.1155/2014/891875

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