The prevalence of proximal hamstring pathology on MRI in the asymptomatic population

Abstract

Purpose

Injury to the proximal hamstring complex (PHC) is becoming more frequently diagnosed. Patients attending our tertiary referral centre demonstrated ‘pathological changes’ in the unaffected normal contralateral PHC on MRI. The prevalence of PHC pathology, however, has not been previously documented in the literature in asymptomatic subjects. It is the hypothesis of this study that the natural history of asymptomatic pathological change on MRI in the PHC is not clear. The aim is to quantify the natural history of PHC degeneration.

Method

Two hundred and fifty-three consecutive patients with an asymptomatic PHC were reviewed retrospectively between 2009 and 2010. The PHC was assessed in multiple MRI planes by a specialist musculoskeletal consultant radiologist.

Results

Five hundred and six proximal hamstrings complexes were reviewed. Eighty-nine patients (35 %) were radiological normal both sides, median age 51 years (range 13–88). Thirty-four patients (13 %) had unilateral pathology, median age 55 years (range 25–89). Of these, 3 patients (1 %) had presence of a complete tear, median age 81 years (range 72–87). Sixteen patients (7 %) had tendinosis, median age 60 years (range 37–78). Fifteen patients (6 %) had a unilateral partial tear, median age 57 years (range 35–78). One hundred and thirty patients (52 %) had bilateral pathology, median age 65 years (range 25–89). Fifty-three patients (21 %) had the presence of bilateral tendinopathy alone, median age 56 years (range 25–89). Twenty-seven patients (11 %) had a partial tear on one side and tendinosis on the other, median age 68 years (range 38–89). Thirty-nine patients (15 %) had evidence of bilateral partial tears, median age 63 years (range 36–89), with 52 % demonstrating a torn conjoined and semi-membranosus tendon. The remaining 48 % had either an isolated tear of the conjoined or the semi-membranosus (the more commonly injured tendon 74 % of the time). Four patients (2 %) had bilateral complete ruptures with a median age of 68 years (range 59–78). Six patients (2 %) had a complete tear on one side and a partial tear on the other, median age 68 years (range 34–83). One patient had a complete tear on one side and tendinosis on the other, age 81 years.

Conclusion

There is a higher prevalence of pathology in the asymptomatic population, 15 % have bilateral partial tears, and 2 % have bilateral complete tears. The semi-membranosus being the most affected, this may help clinically stratify the need for surgical intervention.

Level of evidence

I.