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Hamstring Avulsion, Surgical Tendon Repair

James Mazzarelli during physical therapy
James Mazzarelli continues to strengthen his hamstring repair in physical therapy.
Source: James J. Mazzarelli, Jr.

James J. Mazzarelli Jr. had just returned from a surfing trip in Costa Rica. Even now, as his 60th birthday approaches, he shows no signs of putting his board away.

However, this wasn't always the case: A few years ago, a severely painful leg injury could have left this active surfer and squash player stuck on the sidelines for good. Fortunately, Samir Mehta, MD, chief of the Division of Orthopaedic Trauma at Penn Medicine, made sure that was not how James' story would end. Dr. Mehta repaired James' hamstring injury and got him back to surfing and squash in a matter of months.

Black-And-Blue Technicolor: Signs of a Hamstring Injury

One day in late June, a few years ago, James was skateboarding by his beach house. "I always skateboarding at the beginning of the season before I get out on my surfboard," he explains. "My back foot came off of the skateboard, but my front foot stayed on and I fell into a split."

Even though he was in pain, James — unaware of how serious his injury was — picked up his skateboard, limped home and headed upstairs. "My wife hollered at me for that," he adds.

James' brother-in-law, a veterinarian, came to look at the injury right away. "He said, "There's not a whole lot of black and blue, so I don't think you tore the tendon, but we've got to monitor it.' But the next day, it was completely black and blue," James recalls.

At that point, he contacted his physician, an internist at Penn Medicine, who came to James' house to examine the injury. A glance at the bruising was all he needed to determine that James should have an MRI. "That's when we discovered that my hamstring was pulled completely off of the pelvic bone," James explains. His physician contacted the head of Penn Orthopaedics, who recommended that James see Dr. Mehta right away.

Illustrated quote by James

Connecting with Dr. Mehta

"James' big issue is that it took him a while to find us. He was diagnosed but he sort of bounced around a little bit, so ultimately he got to us a little late," explains Dr. Mehta. "Usually, we try to fix injuries like his within 2 or 3 weeks, and we were well beyond that window. But he was so active and healthy, and we wanted to give him the best opportunity to get back to his normal functioning," he says.

The day after they first spoke, James went to Dr. Mehta's office for a pre-op consultation; Three days later, he was in the operating room.

Repairing the Hamstring Injury

Time was of the essence: The longer James waited, the more likely his tendon would retract into his thigh — making repair more difficult. During the procedure, Dr. Mehta made an incision in James' thigh. Fortunately, Dr. Mehta was able to retrieve the tendon from the middle of the thigh. He then laced the tendon through a hole he drilled in James' pelvic bone, which was sutured it to itself.

"After the surgery, he came to my room with a group of residents, woke me up and explained everything," James remembers. "Dr. Mehta said regaining motion early on was an important part of recovery from this type of hamstring injury," James details. "He had me on crutches the next day. I did some tests with the rehab people at Penn and they released me. I had planned a trip to Maine, so I headed there two days after my surgery."

Getting Back to Activity

The trip was a success. Once he returned from Maine, James began rehabilitation. His physical therapist, Joe Zarett, coordinated with Dr. Mehta to get James back to his usual level of activity. He was back to playing squash just five months after his injury.

"Over time, the range of motion in my hamstring came back and the elasticity in the tendon did its magic," James explains. "In a 1-hour squash match, you're probably lunging on each leg 100 times, and I have no problem with that."

And as soon as the weather was right the following spring, James returned to surfing as well. The only thing James doesn't do anymore is skateboard. "The accident was incredibly painful. So when I look at a skateboard, all I can think about is the pain," he says.

But thanks to Dr. Mehta, he says, he can still do surfing and squash — and enjoy life again.

Even if you aren't looking to hit the waves like James, contact Penn Orthopaedics if you need a specialist like Dr. Mehta to diagnose and repair an injury.

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