Assessment of Physical Examination and Magnetic Resonance Imaging Findings of Hamstring Injury as Predictors for Recurrent Injury

Abstract

Study Design: Prospective cohort study. Objective: To examine clinical and magnetic resonance imaging (MRI) features of hamstring muscle injury to determine if any are predictive for recurrent injury. Background: Hamstring muscle strain injury and subsequent recurrent injury are common. Little information exists on factors that may increase the risk for recurrent injury. Methods and Measures:The subjects were athletes from 3 professional Australian Rules football teams (n = 162). Anthropometric measurements, clinical signs, convalescent interval, and MRI assessment and measurement were undertaken and recorded in athletes with hamstring muscle strain injury. Athletes were followed for the presence, or absence, of recurrent injury to the same-side posterior thigh over the same and subsequent playing seasons. Results: Thirty athletes met criteria for hamstring injury. Twelve (40%) of 30 athletes had recurrent injury within the same season, with an additional 7 athletes having recurrent injury in the subsequent season. None of the features examined were associated with increased recurrent injury risk within the same playing season. Statistical analysis demonstrated that when combining the same with the subsequent playing season a larger size of initial hamstring injury, as measured by MRI, was associated with an increased risk for recurrent injury (P Ͻ .01). A measured transverse size of injury greater than 55% of the muscle, or calculated volume of injury greater than 21.8 cm 3 , resulted in an increased risk for hamstring recurrence of 2.2 (95% CI, 0.88-5.32) and 2.3 (95% CI, 0.94-5.81) times, respectively, when compared to athletes with hamstring injuries below these measurements. Conclusions: A larger size of hamstring injury was indicative of higher risk for recurrent injury but only after the subsequent playing season was considered along with the same playing season.None of the other parameters tested, including a shorter convalescent interval and clinical features, were associated with an increased risk for recurrent injury. However, due to low sample size the certainty of these conclusions may be limited. J Orthop Sports Phys Ther 2006;36(4):215-224.

Value of Sonography Combined With Clinical Assessment to Evaluate Muscle Injury Severity in Athletes

“…The MRI measurements of lesion size, including height on longitudinal sections above the cross-sectional surface, may be useful. 8 However, the available data are limited and contradictory, particularly regarding the influence of initial lesion size on time to healing 13,26 and recurrence risk 27 after acute hamstring strains. We studied a broad range of muscle injuries, including impact and intrinsic injuries, at a variety of sites in athletes at different performance levels.…”

Acute Hamstring Muscle Injury: Types, Rehabilitation, and Return to Sports

“…Magnetic resonance imaging (MRI) is more accurate in the assessment of acute hamstring injuries than most other imaging modalities (Connell et al 2004;Verrall et al 2006;Koulouris et al 2007;Askling et al 2013a). It has the ability to diagnose hamstring pathology, such as subtle tendinosis (tendinopathy), tears and low-grade bursitis for the purposes of guiding rehabilitation and possible radiologically guided intervention (Verrall et al 2006;Askling et al 2013a).…”

Conservative Treatment of Muscle Injuries: From Scientific Evidence to Clinical Practice

“…However, the same authors affirm that more detailed analysis of the injury profile was achieved using MRI during the healing phase. In the only study to relate radiological parameters of hamstring injury to injury recurrence on return to competition Verrall et al (2006) showed that a larger size of hamstring injury was indicative of higher risk for recurrent injury but only after the subsequent playing season was considered along with the same playing season.…”