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Intramuscular tendon injury is not associated with an increased hamstring reinjury rate within 12 months after return to play
  1. Anne D van der Made1,2,3,4,
  2. Emad Almusa1,
  3. Gustaaf Reurink2,3,5,
  4. Rod Whiteley1,
  5. Adam Weir1,6,
  6. Bruce Hamilton7,
  7. Mario Maas3,4,8,
  8. Aston S H Ngai1,
  9. Maarten H Moen5,
  10. Gert Jan Goudswaard1,
  11. Johannes L Tol1,3,4
  1. 1Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  3. 3Academic Center for Evidence-based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands
  4. 4Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
  5. 5The Sports Physicians Group, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  6. 6Erasmus MC Center for Groin Injuries, Department of Orthopaedics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  7. 7High Performance Sport New Zealand, Auckland, New Zealand
  8. 8Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  1. Correspondence to Johannes L Tol, Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar; johannes.tol{at}aspetar.com

Abstract

Background Acute hamstring injury that includes intramuscular tendon injury has been suggested to be associated with increased reinjury risk. These observations were based on a relatively small number of retrospectively analysed cases.

Objective To determine whether intramuscular tendon injury is associated with higher reinjury rates in acute hamstring injury.

Methods MRIs of 165 athletes with an acute hamstring injury were obtained within 5 days of injury. Treatment consisted of a standardised criteria-based rehabilitation programme. Standardised MRI parameters and intramuscular tendon injury, the latter subdivided into tendon disruption and waviness, were scored. We prospectively recorded reinjuries, defined as acute onset of posterior thigh pain in the same leg within 12 months after return to play.

Results Participants were predominantly football players (72%). Sixty-four of 165 (39%) participants had an index injury with intramuscular hamstring tendon disruption, and waviness was present in 37 (22%). In total, there were 32 (19%) reinjuries. There was no significant difference (HR: 1.05, 95% CI 0.52 to 2.12, P=0.898) in reinjury rate between index injuries with intramuscular tendon disruption (n=13, 20%) and without tendon disruption (n=19, 20%). There was no significant difference in reinjury rate (X²(1)=0.031, P=0.861) between index injuries with presence of waviness (n=7, 19%) and without presence of waviness (n=25, 20%).

Conclusion In athletes with an acute hamstring injury, intramuscular tendon injury was not associated with an increased reinjury rate within 12 months after return to play.

  • Hamstring injury
  • muscle injury
  • magnetic resonance imaging
  • MRI
  • tendon
  • intramuscular tendon
  • central tendon
  • intratendinous
  • re-injury
  • recurrence

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Footnotes

  • Contributors ADvdM was involved in study design, data collection, data analysis, data interpretation and drafting. EA and MM were involved for their radiological expertise, and in the evaluation of MRI scans and drafting. RW, BH, ASHN, MHM and GJG were involved in data interpretation and drafting. JLT, GR and AW were involved in study design, data interpretation and drafting.

  • Funding The Qatar study was internally funded by Aspetar. The Dutch trial was supported by Arthrex Medizinische Instrumente and the Royal Dutch Football Association.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Medical Ethics Board of Aspetar and the Medical Ethical Committee of South West Holland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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