Name of the Procedure:

Lengthening of Hamstring Tendon; Multiple Tendons, 1 Leg (Commonly referred to as Hamstring Tendon Lengthening or Hamstring Release)

Summary

Hamstring tendon lengthening involves surgically extending one or more tendons in the hamstring muscle group of one leg to improve flexibility and function. This procedure is typically performed to alleviate tightness or contractures that limit movement and cause discomfort.

Purpose

This procedure addresses hamstring tightness or contractures primarily due to conditions like cerebral palsy, muscular dystrophy, or hamstring injuries. The goal is to improve range of motion, reduce pain, and enhance overall mobility and function of the leg.

Indications

• Chronic hamstring tightness unresponsive to non-surgical treatments
• Difficulty in extending the knee fully
• Pain and discomfort during physical activities
• Walking abnormalities (gait issues) or crouched posture

Preparation

• Preoperative fasting as per anesthesiologist’s recommendations
• Adjustments in current medications (e.g., blood thinners)
• Diagnostic tests such as physical examination, MRI or ultrasound to assess tendon condition

Procedure Description

1. The patient is placed under either general or regional anesthesia.
2. The surgeon makes small incisions along the back of the thigh.
3. The identified hamstring tendons are carefully isolated.
4. Tendons are lengthened either through release or z-lengthening techniques.
5. Incisions are closed with sutures, and the leg is often placed in a soft cast or brace.

Tools: Scalpel, retractors, sutures, and surgical scissors.

Duration

The procedure typically takes around 1 to 2 hours.

Setting

The procedure is performed in a hospital operating room or a surgical center.

Personnel

• Orthopedic surgeon or pediatric surgeon (depending on patient age)
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Infection at the surgical site
• Excessive bleeding or blood clots
• Nerve injury
• Scarring
• Recurrence of tendon tightness
• Reaction to anesthesia

Benefits

• Improved flexibility and range of motion in the leg
• Reduction in pain and discomfort
• Enhanced ability to participate in physical activities and improved gait
• Benefits are generally realized within weeks to months post-surgery

Recovery

• Post-operative pain management with medications
• Physical therapy starting a few days post-surgery to aid in recovery and range of motion exercises
• Regular follow-up appointments to monitor healing
• Typical recovery period is about 4-6 weeks, with complete return to activities in several months
• Temporary restrictions on weight-bearing activities and exercises

Alternatives

• Physical therapy and stretching exercises
• Use of orthotic devices (braces)
• Botulinum toxin (Botox) injections for temporary relief
• Discussion of pros and cons of less invasive options versus surgical intervention

Patient Experience

• Pre-procedure anxiety and post-procedure grogginess from anesthesia
• Initial discomfort and pain managed with medication
• Gradual improvement in mobility with adherence to physical therapy regimen
• Emotional support from family and healthcare team is vital for positive recovery experience