Total proximal hamstring ruptures: clinical and MRI aspects including guidelines for postoperative rehabilitation

  • Carl M. Askling
  • George Koulouris
  • Tönu Saartok
  • Suzanne Werner
  • Thomas M. Best
Sports Medicine


The aim of this article is to provide a state-of-the-art review for treatment of acute, total proximal hamstring tendon ruptures. For total proximal hamstring tendon ruptures, early (<2–3 w) surgical refixation minimizes muscle atrophy and facilitates a somewhat predictable time course for healing and rehabilitation. A postoperative rehabilitation program is detailed that has been used by one physical therapist for the past 7 years on over 200 patients with surgical repair for total proximal hamstring tendon rupture. One re-rupture has occurred, 7 months after surgery, following the rehabilitation program described herein. The rehabilitation program, including avoidance of postoperative bracing, appears effective for total proximal hamstring ruptures. Early surgery together with a specific rehabilitation program appears to be the treatment of choice for timely and safe return to sport and an active lifestyle.

Level of evidence V.


Physical therapy Surgical treatment Tendon injuries Thigh muscle injuries 



The authors thank Dr Sven Jönhagen, Danderyd Sjukhus, Stockholm, and Dr Karl Eriksson, Södersjukhuset, Stockholm, for their skilful cooperation and assistance.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Carl M. Askling
    • 1
    • 2
  • George Koulouris
    • 3
    • 4
  • Tönu Saartok
    • 5
    • 6
  • Suzanne Werner
    • 5
    • 8
  • Thomas M. Best
    • 7
  1. 1.The Swedish School of Sport and Health SciencesStockholmSweden
  2. 2.Section of Orthopaedics and Sports Medicine, Department of Molecular Medicine and SurgeryKarolinskaInstitutetStockholmSweden
  3. 3.Melbourne Radiology ClinicEast MelbourneAustralia
  4. 4.Centre for Orthopaedic Research, School of SurgeryUniversity of Western AustraliaNedlandsAustralia
  5. 5.Sports Trauma Research CenterKarolinska InstitutetStockholmSweden
  6. 6.Department of OrthopaedicsVisby HospitalVisbySweden
  7. 7.Department of Family Medicine, Sports Health and Performance InstituteThe Ohio State UniversityColumbusUSA
  8. 8.Department of Molecular Medicine and SurgeryStockholmSweden

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