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The prognostic value of MRI in determining reinjury risk following acute hamstring injury: a systematic review
  1. Moniek van Heumen1,
  2. Johannes L Tol2,3,4,
  3. Robert-Jan de Vos5,
  4. Maarten H Moen6,7,
  5. Adam Weir2,8,
  6. John Orchard9,
  7. Gustaaf Reurink10
  1. 1 Department of Sports Medicine, VieCuri Medisch Centrum, Venlo, Limburg, The Netherlands
  2. 2 Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
  3. 3 Department of Sports Medicine, The Sports Physician Group, OLVG, Amsterdam, The Netherlands
  4. 4 Department of Sports Medicine, Aspetar Orthopaedics and Sports Medicine Hospital, Doha, Qatar
  5. 5 Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  6. 6 Department of Sports Medicine, Bergman Clinics, Naarden, The Netherlands
  7. 7 The Sports Physician Group, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands
  8. 8 Sports Groin Pain Centre, Aspetar Orthopaedics and Sports Medicine Hospital, Doha, Qatar
  9. 9 School of Public Health, University of Sydney, Sydney, Australia
  10. 10 The Sports Physician Group, Amsterdam, The Netherlands
  1. Correspondence to Moniek van Heumen, Department of Sports Medicine, VieCui Medisch Centrum, Tegelseweg 210, Venlo 5912 BL, The Netherlands; moniekvanheumen{at}


Background A challenge for sports physicians is to estimate the risk of a hamstring re-injury, but the current evidence for MRI variables as a risk factor is unknown.

Objective To systematically review the literature on the prognostic value of MRI findings at index injury and/or return to play for acute hamstring re-injuries.

Data sources Databases of PubMed, Embase, MEDLINE, Scopus, CINAHL, Google Scholar, Web of Science, LILACS, SciELO, ScienceDirect, ProQuest, SPORTDiscus and Cochrane Library were searched until 20 June 2016.

Study eligibility criteria Studies evaluating MRI as a prognostic tool for determining the risk of re-injury for athletes with acute hamstring injuries were eligible for inclusion.

Data analysis Two authors independently screened the search results and assessed risk of bias using standardised criteria from a consensus statement. A best-evidence synthesis was used to identify the level of evidence. Post hoc analysis included correction for insufficient sample size.

Results Of the 11 studies included, 7 had a low and 4 had a high risk of bias. No strong evidence for any MRI finding as a risk factor for hamstring re-injury was found. There was moderate evidence that intratendinous injuries were associated with increased re-injury risk. Post hoc analysis showed moderate evidence that injury to the biceps femoris was a moderate to strong risk factor for re-injury.

Conclusion There is currently no strong evidence for any MRI finding in predicting hamstring re-injury risk. Intratendinous injuries and biceps femoris injuries showed moderate evidence for association with a higher re-injury risk.

Systematic review registration Registration in the PROSPERO International prospective register of systematic reviews was performed prior to study initiation (registration number CRD42015024620).

  • Hamstring
  • Recurrent
  • MRI
  • Risk factor
  • Thigh

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  • Contributors All authors have contributed to the development of the research question and study design. MvH and RdV developed the literature search, whilst GR and MHM performed the study selection. JLT, R-JdV and JO achieved the risk of bias assessment. MvH extracted the data and made a data synthesis of the included studies. MvH developed the first draft, all authors developed the subsequent drafts of the manuscript. All authors reviewed and approved the manuscript.

  • Funding JT's institute received funding from the Marti-Keuning-Eckhardt Foundation for the preparation of this review, but none of the authors was personally financially compensated.

  • Competing interests None declared.

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