PROXIMAL HAMSTRING TENDON RUPTURE

Rupture of the proximal hamstring tendon is a relatively rare injury and is typically caused by a traumatic incident, such as falling or a sports injury. A complete rupture, meaning the tendon is completely pulled off the bone, can be treated conservatively with physical therapy and/or injections or surgically. Depending on the acuteness of the injury and your hobbies and goals, your doctor may recommend one treatment option over the other. Patients treated non-operatively (meaning with physical therapy or injections and no surgery) can do fairly well in the appropriate setting. However, there is usually about a 35% decrease in strength and function in that hamstring after this type of injury. Patients who want to return to high level sports or who are very active usually opt for surgery. It is best to have the surgery done within the first three weeks after the injury if possible, before scar tissue develops around the retracted tendon. Surgery is done through an open incision along the crease of your buttock. One to three anchors are inserted into ischial tuberosity (where the hamstring to attaches) and from these anchors are sutures. These sutures are sewn into the end of the detached tendon and pulled back up to the bone and the sutures are tied. The sutures can withhold some force but the outcome of the surgery is dependent on your body’s ability to heal the tendon back down to the bone. This takes about 6-12 weeks.

Wound Care

• Remove Bulky dressing day 2 after surgery. Leave Mepilex and plastic covering in place
• We recommend you sponge bath until your wound is checked by Dr. Pettit 5-7 days from surgery (your entire bandage will be changes at that time).

Ice

• Apply ice packs to your limb as tolerated every 2 hours for no more than 20 min for swelling and pain relief

Brace

• After surgery, you will need a hip brace which will prevent you from being able to flex at the hip. You will be fitted for this brace prior to surgery and you must bring this brace with you the day of surgery. The brace must be worn at all times except for bathing and dressing. At the initial post-op appointment, further brace wear will be addressed. The brace should be worn as directed by Dr. Pettit, usually for about 4 weeks. This brace is essential in preventing any stress on the tendon repair.

Crutches & Weight bearing status

• You will be toe touch-weight bearing on the leg you had surgery on with hip brace on at all time, unless otherwise instructed. Toe touch means that you can only place your toe on the floor for pivoting and transferring. You will be provided crutches after surgery and will work with nursing on proper crutch walking prior to discharge from the surgery center. Weightbearing status will be discussed with Dr. Pettit at your first post-op visit.

Physical Therapy

• This is variable and depends on the patient. In general, you should expect to be in PT for about 4-6 months. The specific PT program and goals will be per Dr. Pettit’s protocol. You will likely start PT 4 weeks out from surgery. You will be provided with a prescription for PT at your follow up appointment and you can choose a facility that is a convenient location for you or she may recommend one for you

Pain Control and Medications

Some swelling and bruising can occur after surgery. Make sure to apply ice to the affected area. Please perform frequent calf pumps to help reduce your swelling. If you are concerned about the amount of swelling or bruising, please contact our office.

1. Pain Medication: Tylenol 1000mg every 8 hours and, unless discussed otherwise, you have been prescribed a narcotic pain medication (Oxycodone 5mg) to take every 4-6 hours as needed.
• DO NOT drive/use any heavy machinery, drink alcohol, make any life-changing or legal decisions (i.e. sign a will), or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity. On rare occasions they may cause confusion or disorientation, we advise you to discontinue this medication should that occur.
• Narcotics can be addictive. Dispose of any excess medication at a police/fire station.
• Take a stool softener (e.g. Colace) while taking narcotic medication, as narcotics may cause constipation.  If this does not help alleviate your constipation, you can try adding miralax or milk of magnesia. Please call our office if this regimen does not alleviate your constipation.
• If you have any questions or concerns about narcotic strength medications, please contact us.
• Journavx (suzetrigine): If Journavx has been prescribed, take it in place of the Oxycodone. Start with a loading dose of 100 mg (two 50 mg tablets), then take one 50 mg tablet twice a day (every 12 hours) for two weeks. If you are not getting adequate pain control with Journavx, you may take Oxycodone instead. Do not take Journavx and Oxycodone at the same time, and avoid grapefruit while taking Journavx.
2. Anti-nausea: Zofran (Ondansetron): Take as prescribed if needed for nausea
3. Anti-Inflammatory: Unless contraindicated due to other health reasons, you have been prescribed a non-steroidal anti-inflammatory drug (Ibuprofen 800mg) for use postoperatively. If you have no personal history of adverse response to anti-inflammatories (NSAIDs), take as prescribed every 8 hours with food to help reduce swelling and pain. Do not take other NSAIDs (Advil, Aleve, etc) with Ibuprofen.
4. DVT prophylaxis: Please take one 81 mg baby Aspirin twice daily for 30 days following surgery to help minimize the risk of blood clot (extremely rare). If you are under age 16, unable to take aspirin for other medical reasons, or currently on anticoagulation, you do not need to take aspirin after surgery.
5. Muscle relaxer: Flexeril (Cyclobenzaprine) for muscle spasms in quadriceps muscle. Take this as needed, it will make you drowsy.

Tylenol and Ibuprofen are the foundation for your pain control regimen

Example dosing: 1000mg Tylenol then 4 hours later 800mg Ibuprofen then 4 hours later repeat- every 4 hours alternate between Tylenol and Ibuprofen. Oxycodone as needed for breakthrough pain.

*You should not exceed 3,000mg of Tylenol or 3,200mg of Ibuprofen in 24 hours.

Bathroom

• Going to the bathroom may be difficult. Please do the best you can with the brace left on. Some patients find a high commode, side cut out commode or a GOGIRL (female urinal) useful. You can also purchase commodes and GOGIRL at a medical supply store or online. Our office is happy to assist as needed.

Driving

• You may not drive while wearing the brace so you should plan on not driving for at least the first 6- 8 weeks if it is your left leg (2 months if you drive a standard transmission) and at least 2 months if it is your right leg. You should also be off all narcotic pain medication prior to driving. We recommend practicing in a parking lot at first.

Dental Work

• Please do not undergo any dental work, including cleanings, six weeks prior to surgery, and six months post-surgery.

Return to Work

• You may return to work as soon as you are comfortable and able to safely weight bear using crutches. This typically occurs 1–4 weeks post-op. Return to work notes can be obtained at your first post-op appointment.

Follow-up Appointment

Your first post-operative appointment will be scheduled 3-7 days following your surgical procedure. If you do not have a post-operative appointment scheduled when you leave following surgery, please call 513-354-3700 to make the appointment or 513-441-5639 (Direct Line to Sandy Evans)

****Signs & Symptoms to Immediately Report****

• Call 911 and go to the nearest hospital if you are having chest pain or trouble breathing.