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MRI observations at return to play of clinically recovered hamstring injuries
  1. Gustaaf Reurink1,2,
  2. Gert Jan Goudswaard2,
  3. Johannes L Tol2,
  4. Emad Almusa3,
  5. Maarten H Moen4,
  6. Adam Weir2,
  7. Jan A N Verhaar1,
  8. Bruce Hamilton5,
  9. Mario Maas6
  1. 1Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
  2. 2Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  3. 3Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  4. 4Department of Sports Medicine, Bergman Clinics, Naarden, The Netherlands
  5. 5Department of Sports Medicine, High Performance Sport New Zealand, Millennium Institute of Sport and Health, Mairangi Bay, Auckland, New Zealand
  6. 6Department of Radiology, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Gustaaf Reurink, Department of Orthopaedics, Erasmus Medical Center, room Hs-104, PO Box 2040, Rotterdam 3000 CA, The Netherlands; g.reurink{at}


Background Previous studies have shown that MRI of fresh hamstring injuries have diagnostic and prognostic value. The clinical relevance of MRI at return to play (RTP) has not been clarified yet. The aim of this study is to describe MRI findings of clinically recovered hamstring injuries in amateur, elite and professional athletes that were cleared for RTP.

Methods We obtained MRI of 53 consecutive athletes with hamstring injuries within 5 days of injury and within 3 days of RTP. We assessed the following parameters: injured muscle, grading of injury, presence and extent of intramuscular signal abnormality. We recorded reinjuries within 2 months of RTP.

Results MRIs of the initial injury showed 27 (51%) grade 1 and 26 (49%) grade 2 injuries. Median time to RTP was 28 days (range 12–76). On MRI at RTP 47 athletes (89%) had intramuscular increased signal intensity on fluid-sensitive sequences with a mean longitudinal length of 77 mm (±53) and a median cross-sectional area of 8% (range 0–90%) of the total muscle area. In 22 athletes (42%) there was abnormal intramuscular low-signal intensity. We recorded five reinjuries.

Conclusions 89% of the clinically recovered hamstring injuries showed intramuscular increased signal intensity on fluid-sensitive sequences on MRI. Normalisation of this increased signal intensity seems not required for a successful RTP. Low-signal intensity suggestive of newly developed fibrous tissues is observed in one-third of the clinically recovered hamstring injuries on MRI at RTP, but its clinical relevance and possible association with increased reinjury risk has to be determined.

  • Hamstring injuries
  • MRI
  • Muscle damage/injuries

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