The value of MRI STIR signal intensity on return to play prognosis and reinjury risk estimation in athletes with acute hamstring injuries

Abstract

Objectives: Previous studies have shown low to moderate evidence for a variety of magnetic resonance imaging (MRI) features as prognostic factors in athletes with hamstring injuries. Short-tau inversion recovery (STIR) signal intensity has not yet been investigated for assessing the prognosis of acute muscle injuries. Our aim was to explore the relationship between MRI STIR signal intensity and time to return to play (RTP) and to investigate the association between MRI STIR and reinjury risk in athletes with acute hamstring injuries. Study design: Case-control study. Methods: We used MRI STIR to measure intramuscular signal intensity in patients with clinically diagnosed hamstring injuries at two time points: at injury and RTP. At injury, we calculated the association of MRI STIR signal intensity with the time to RTP and reinjury risk. At RTP, the association of MRI STIR signal intensity and reinjury risk and the change in MRI STIR signal intensity over time on reinjury risk was evaluated. Results: 51 patients were included. We found increased MRI STIR signal intensity: (1) at time of injury not to be associated with time to RTP, (2) at time of injury to be associated with a slightly lower risk for reinjury: odds 0.986 (0.975-0.998, p = 0.02) and (3) at RTP not to be associated with reinjury risk. (4) We found no association between the change in MRI STIR signal intensity over time and reinjury risk. Conclusion: Increased MRI STIR signal intensity at injury has no value in time to RTP prognosis, but is associated with a reduced reinjury risk.

Diffusion tensor imaging and quantitative T2 mapping to monitor muscle recovery following hamstring injury

“…9 Furthermore, recent work showed that edema is often still present upon RTP and is therefore not an appropriate outcome measure to indicate recovery or to predict the recovery time. 12 Therefore, there is a clinical need to explore advanced, quantitative methods to characterize muscle tissue recovery after severe injury.…”

“…More specifically, Reurink and colleagues showed that only the absence of hyperintense signal on fluid‐sensitive sequences was moderately associated with a shorter time to return to play (RTP) and that proximal tendon involvement was associated with a longer time to RTP 9 . Furthermore, recent work showed that edema is often still present upon RTP and is therefore not an appropriate outcome measure to indicate recovery or to predict the recovery time 12 . Therefore, there is a clinical need to explore advanced, quantitative methods to characterize muscle tissue recovery after severe injury.…”

MRI findings prior to return to play as predictors of reinjury in professional athletes: a novel decision-making tool

“…Despite the fact that in recent years certain publications have downplayed or questioned the role of MRI in monitoring muscle injuries [ 21 , 26 ], the current results demonstrate that certain MRI findings are predictive of reinjuries and may be a useful tool in the multifactorial decision-making process of recovery and RTP [ 35 – 37 ].…”

“…Also, global improvement in oedema was frequently observed in non-reinjury and reinjury groups in similar percentage. In other studies, different patterns of muscle interstitial oedema in both baseline and control MRI prior to RTP have not been assessed, with previous results primarily based on the measurable extent of oedema [ 20 , 23 , 26 ]. The cotton-like oedema that we have shown in our study is similar to the peritendinous ovoid or subfascial ring oedema indicated by Kho et al [ 34 ] in professional soccer players with suspected acute thigh muscle injuries, that they called exercise-related signal.…”

“…MRI appearances of muscle injuries help to categorise the degree and help guide when the athlete may return to play [9][10][11][12]. A number of studies have associated MRI data obtained at the time of injury with recovery times [10][11][12][13][14][15][16][17][18][19][20], and other studies have explored the usefulness of MRI performed during the healing phase prior to RTP to anticipate recurrence of lesions [21][22][23][24][25][26], but definitive conclusions have not been drawn.…”