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Is surgery recommended for one avulsed hamstring tendon with retraction.

Hi Doctors,

2 weeks ago, my long head of the bicep femoris on the left hamstring, from the myotendinois junction, with a retraction of 70mm.
I saw a specialist and he said it will scar and be fine, and opted for no surgery.

My main concern is if  I regain function of the bicep femoris with no surgery with such a large retraction. I'm curious how will it regain functions as it is not working at the moment. I am not an elite athlete, but very active including running and powerlifting. 

If function is not regained should I do surgery?If surgery is recommended, what time frame would be most effective.

I thank you in advance and thank you for your time.


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Dr. Hamid R
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Dear @Ian 

I am sorry to hear of your injury. Injuries to the biceps femoris have indeed been reported in isolation or with concomitant injuries to the adjacent ligaments within the knee. You seem to describe a Grade 4 injury - Complete muscle injury with discontinuity and retraction. While surgical repair is generally advocated to restore the native anatomic features to minimize loss of function and strength, there is still no consensus on optimal management with regard to successful return to sport. This is perhaps why you had been advised against surgery.

Hamstring injuries are the most common injury in sports. Unfortunately, they are associated with long rehabilitations and have a tendency to recur. In isolated injuries, he treatment is conservative, with the use of anti-inflammatory drugs in the acute phase followed by a muscle rehabilitation program. Proximal avulsions have shown better results with surgical repair. 

In general, conservative therapy is indicated for single-tendon acute proximal tendon avulsions or multiple tendon lesions with less than 2 cm of retraction. 
Surgical treatment is the best option for ischial apophysis avulsions in skeletally immature patients, avulsions with the HS bone fragment, and proximal avulsions of the entire HS complex. Surgery is also indicated in patients with avulsions in one or two tendons and retractions greater than 2cm. In recreational athletes or inactive patients, surgery is indicated only if the patient is symptomatic.

With the information you have given, you have mentioned a retraction of 70mm = 7cm. You also mention that you are not an elite athlete. Decision for surgery or primary rehabilitation in your case is a difficult and challenging one that needs to be made in a shared and mutual manner with your physician. I hope this helps with some clarification at least.

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@Ian
Thank you for your input, the weakness of the hamstring has made me quite sad, but I'll pursue some surgical intervention even to restore some more strength. 

I thank you again for your kindness and valuable insight