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Magnetic Resonance Imaging in Acute Hamstring Injury: Can We Provide a Return to Play Prognosis?

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Abstract

Background

Sports physicians are increasingly requested to perform magnetic resonance imaging (MRI) of acute hamstring muscle injuries and to provide a prognosis of the time to return to play (RTP) on the basis of their findings.

Objectives

To systematically review the literature on the prognostic value of MRI findings for time to RTP in acute hamstring muscle injuries.

Data Sources

The databases of PubMed, EMBASE, CINAHL, Web of Science and Cochrane Library were searched in June 2013.

Study Eligibility Criteria

Studies evaluating MRI as a prognostic tool for determining time to RTP in athletes with acute hamstring injuries were eligible for inclusion.

Data Analysis

Two authors independently screened the search results and assessed risk of bias using criteria for quality appraisal of prognosis studies. A best-evidence synthesis was used to identify the level of evidence.

Results

Of the 12 studies included, one had a low risk of bias and 11 a high risk of bias. There is moderate evidence that injuries without hyperintensity on fluid-sensitive sequences are associated with a shorter time to RTP and that injuries involving the proximal free tendon are associated with a longer time to RTP. Limited evidence was found for an association of central tendon disruption, injury not affecting the musculotendinous junction and a total rupture with a longer time to RTP. The other MRI findings studied showed either no association or there was conflicting evidence.

Conclusion

There is currently no strong evidence for any MRI finding that gives a prognosis on the time to RTP after an acute hamstring injury, owing to considerable risks of bias in the studies on this topic.

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References

  1. Feeley BT, Kennelly S, Barnes RP, et al. Epidemiology of National Football League training camp injuries from 1998 to 2007. Am J Sports Med. 2008;36:1597–603.

    Article  PubMed  Google Scholar 

  2. Shankar PR, Fields SK, Collins CL, et al. Epidemiology of high school and collegiate football injuries in the United States, 2005–2006. Am J Sports Med. 2007;35:1295–303.

    Article  PubMed  Google Scholar 

  3. Ekstrand J, Hägglund M, Waldén M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39:1226–32.

    Article  PubMed  Google Scholar 

  4. Alonso J-M, Edouard P, Fischetto G, et al. Determination of future prevention strategies in elite track and field: analysis of Daegu 2011 IAAF championships injuries and illnesses surveillance. Br J Sports Med. 2012;46:505–14.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports Med. 2002;36:39–44.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Kerkhoffs GMMJ, van Es N, Wieldraaijer T, et al. Diagnosis and prognosis of acute hamstring injuries in athletes. Knee Surg Sports Traumatol Arthrosc. 2013;21:500–9.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Koulouris G, Connell D. Hamstring muscle complex: an imaging review. Radiographics. 2005;25:571–86.

    Article  PubMed  Google Scholar 

  8. Askling CM, Tengvar M, Saartok T, et al. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med. 2008;36:1799–804.

    Article  PubMed  Google Scholar 

  9. Hayden JA, Côté P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144:427–37.

    Article  PubMed  Google Scholar 

  10. Van Tulder M, Furlan A, Bombardier C, Editorial Board of the Cochrane Collaboration Back Review Group, et al. Updated method guidelines for systematic reviews in the Cochrane collaboration back review group. Spine. 2003;28:1290–9.

    PubMed  Google Scholar 

  11. Askling CM, Tengvar M, Saartok T, et al. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med. 2007;35:197–206.

    Article  PubMed  Google Scholar 

  12. Askling CM, Tengvar M, Saartok T, et al. Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics. Am J Sports Med. 2007;35:1716–24.

    Article  PubMed  Google Scholar 

  13. Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013;47:953–9.

    Article  PubMed  Google Scholar 

  14. Comin J, Malliaras P, Baquie P, et al. Return to competitive play after hamstring injuries involving disruption of the central tendon. Am J Sports Med. 2013;41:111–5.

    Article  PubMed  Google Scholar 

  15. Connell DA, Schneider-Kolsky ME, Hoving JL, et al. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol. 2004;183:975–84.

    Article  PubMed  Google Scholar 

  16. Schneider-Kolsky ME, Hoving JL, Warren P, et al. A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries. Am J Sports Med. 2006;34:1008–15.

    Article  PubMed  Google Scholar 

  17. Ekstrand J, Healy JC, Waldén M, et al. Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med. 2012;46:112–7.

    Article  PubMed  Google Scholar 

  18. Gibbs NJ, Cross TM, Cameron M, et al. The accuracy of MRI in predicting recovery and recurrence of acute grade one hamstring muscle strains within the same season in Australian Rules football players. J Sci Med Sport. 2004;7:248–58.

    Article  CAS  PubMed  Google Scholar 

  19. Rettig AC, Meyers S, Kersey PA, et al. Categorization of hamstring strain injuries by MRI and playing time lost in professional football players. NATA News 2008;29–32.

  20. Silder A, Sherry MA, Sanfilippo J, et al. Clinical and morphological changes following 2 rehabilitation programs for acute hamstring strain injuries: a randomized clinical trial. J Orthop Sports Phys Ther. 2013;43:284–99.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Slavotinek JP, Verrall GM, Fon GT. Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition. AJR Am J Roentgenol. 2002;179:1621–8.

    Article  PubMed  Google Scholar 

  22. Verrall GM, Slavotinek JP, Barnes PG, et al. Diagnostic and prognostic value of clinical findings in 83 athletes with posterior thigh injury: comparison of clinical findings with magnetic resonance imaging documentation of hamstring muscle strain. Am J Sports Med. 2003;31:969–73.

    PubMed  Google Scholar 

  23. Reurink G, Goudswaard GJ, Tol JL, et al. Therapeutic interventions for acute hamstring injuries: a systematic review. Br J Sports Med. 2012;46:103–9.

    Article  PubMed  Google Scholar 

  24. Heiderscheit BC, Sherry MA, Silder A, et al. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40:67–81.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Koulouris G, Connell DA, Brukner P, et al. Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med. 2007;35:1500–6.

    Article  PubMed  Google Scholar 

  26. Bahr R, Holme I. Risk factors for sports injuries: a methodological approach. Br J Sports Med. 2003;37:384–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

No sources of funding were used to assist in the preparation of this review. The authors have no potential conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Orthopedics, Erasmus Medical Centre, Room Hs-104, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    Gustaaf Reurink & Elisabeth G. Brilman

  2. Department of Sports Medicine, Medical Centre The Hague, Antoniushove, Leidschendam, The Netherlands

    Robert-Jan de Vos

  3. Department of Radiology, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands

    Mario Maas

  4. Department of Sports Medicine, Bergman Clinics, Naarden, The Netherlands

    Maarten H. Moen

  5. The Sports Physician Group, Amsterdam, The Netherlands

    Maarten H. Moen

  6. Department of Sports Medicine, Aspetar Orthopedics and Sports Medicine Hospital, Doha, Qatar

    Adam Weir, Gert Jan Goudswaard & Johannes L. Tol

Authors
  1. Gustaaf Reurink
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  2. Elisabeth G. Brilman
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  3. Robert-Jan de Vos
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  4. Mario Maas
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  5. Maarten H. Moen
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  6. Adam Weir
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  7. Gert Jan Goudswaard
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  8. Johannes L. Tol
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Correspondence to Gustaaf Reurink.

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Reurink, G., Brilman, E.G., de Vos, RJ. et al. Magnetic Resonance Imaging in Acute Hamstring Injury: Can We Provide a Return to Play Prognosis? . Sports Med 45, 133–146 (2015). https://doi.org/10.1007/s40279-014-0243-1

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  • DOI: https://doi.org/10.1007/s40279-014-0243-1

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