Complete or severe tear of the proximal hamstring tendon(s) off the ischial tuberosity.
A proximal hamstring avulsion is separation of the conjoint hamstring tendon origin — semimembranosus, semitendinosus, and biceps femoris long head — from the ischial tuberosity, ranging from a partial tear to a complete rupture with tendon retraction. It typically follows a forceful eccentric load with the hip flexed and knee extended, such as a slip during water-skiing or an aggressive hip-hinge movement.
Whether the tear is complete and retracted versus partial and non-retracted determines the management pathway: retracted tendon has a much lower likelihood of healing adequately with conservative care alone, so surgical repair is generally favoured to restore length-tension and strength. Delayed recognition allows further retraction and scarring, making later repair technically harder and outcomes less predictable, so early identification and timely referral is the key clinical decision point.
Diagnosis is suspected from mechanism and history — a posterior thigh 'pop', pain near the ischial tuberosity, bruising, and often a palpable gap with marked hamstring weakness on examination. MRI is the reference standard, used to confirm which tendons are involved and to measure retraction distance, which directly informs the choice between surgical repair and structured rehabilitation.
Retraction distance on imaging does not translate neatly into a predictable functional outcome, and even technically successful surgical repair does not guarantee return to preinjury sporting level, so counselling should avoid firm timelines or guarantees. These injuries are also easily under-recognised as simple hamstring strains early on, so a suggestive mechanism with a palpable defect or significant weakness should prompt imaging rather than a default conservative strain protocol.
This guide was auto-drafted and is pending editorial review.