Dak Prescott suffered a partial proximal hamstring tendon avulsion in the final minutes of the 3^rd quarter loss to the Atlanta Falcons in the week 9 game.  He is planning to undergo season ending surgery to repair the injury.  

A proximal hamstring tendon avulsion is a type of injury where one or more of the tendons of the hamstring muscles (the biceps femoris, semitendinosus, and semimembranosus) tear away from their attachment points on the pelvis, typically at the ischial tuberosity (the bony prominence at the bottom of the pelvis). This injury can occur suddenly, often as a result of forceful movements like sprinting, sudden deceleration, or jumping.

Key aspects of the injury include:

• Location of the injury: The tendons at the proximal (upper) part of the hamstring muscles, where they attach to the ischial tuberosity.
• Mechanism of injury: A forceful contraction of the hamstrings during activities such as running, especially during sprinting or when a person suddenly changes direction.

 Symptoms: 

• Severe pain in the buttock or back of the thigh.
• Bruising and swelling in the affected area.
• Difficulty in walking or bearing weight on the affected leg.
• In some cases, there is a palpable gap or a bulge in the thigh due to retraction of the muscle.

Diagnosis and Treatment:

• Diagnosis typically involves a clinical examination, and imaging such as MRI is used to confirm the avulsion and determine the extent of the injury.
• Treatment depends on the severity of the injury. In mild to moderate cases, conservative management such as rest, ice, compression, and elevation (R.I.C.E.), followed by physical therapy, and potentially platelet rich plasma may be sufficient. In more severe cases where the tendon has fully avulsed from the bone, for large partial tears in high level athletes, or chronic partial tears that did not respond to conservative treatment surgical repair may be required to reattach the tendon to the ischial tuberosity.

The surgical approach is generally made through a transverse incision within the gluteal crease, which can be extended distally in a “T” configuration for larger chronic retracted tears. In a study by Belk, et al, published in the Orthopedic Journal of Sports Medicine in 201, a meta-analysis of 16 studies including 374 complete hamstring avulsion tears and 93partial proximal tears had a 93% rate return to sport for complete tears and 96% for partial tears.  The mean time to return to sport was 5.7 months, and 83.5% of patients (330/395) returned to their preinjury activity level. 

While it looks like Dak Prescott will be out for the remainder of the season he has an excellent chance of fully recovering for next year.

At Total Orthopedics and Sports Medicine we have surgeons with extensive experience treating proximal hamstring tendon tears helping athletes get back to full activity.