Hamstring tendon pathology is frequent in athletes, and proximal tendon avulsion can lead to significant limitations and lower performance in sports activities. For a decision regarding the best treatment, we should consider the age and activity status of the patient, the time since the injury, the tendons involved, their retraction, and neurologic symptoms. Surgical treatment is usually recommended for active patients with two or three tendon avulsions with retraction (>2 cm) or after failed conservative treatment. Ruptures of one or two tendons with up to 1–2 cm of retraction can be managed nonoperatively, especially in less active patients, although the threshold for surgical treatment should be lower in athletes. Surgical repair of hamstring avulsions is associated with high patient satisfaction, high rate of return to sports, and a low major complication rate.