Chronic Hamstring Tendon Ruptures

Hamstring tendon injuries are common, accounting for up to 30% of all injuries in athletes. Delayed diagnosis, failed initial conservative therapy, or repetitive injuries can lead to chronicity. This, in turn, is associated with persistent pain, loss of strength, and potentially neurological symptoms, often resulting in surgical intervention. Current literature is heterogeneous and focuses primarily on surgical treatment. Direct anchor suture repairs are described, as well as restoration of continuity using allograft or autograft interposition. Clinical outcomes are difficult to compare due to differing definitions, approaches, assessments, and postoperative treatments. However, functional results suggest that surgical treatment can achieve satisfactory outcomes, often improving the postoperative condition compared to the preoperative state. This applies to activities of daily living as well as the return to athletic activity. The latter, however, is expected to take longer than with the surgical treatment of acute injuries and is not guaranteed in all cases. Due to the chronic condition with adhesions of scar tissue around the tendon and the sciatic nerve, the rate of postoperative complications, particularly neurological ones, as well as the rate of re-ruptures, is increased. Individualized decision-making and planning of the surgical approach, taking into account the injury and patient's age, subjective and objective complaints including neurological symptoms, imaging findings, and functional demands, are necessary to achieve a satisfactory outcome.