Background MRI is frequently used in addition to clinical evaluation for predicting time to return to sport (RTS) after acute hamstring injury. However, the additional value of MRI to patient history taking and clinical examination remains unknown and is debated.

Aim To prospectively investigate the predictive value of patient history and clinical examination at baseline alone and the additional predictive value of MRI findings for time to RTS using multivariate analysis while controlling for treatment confounders.

Methods Male athletes (N=180) with acute onset posterior thigh pain underwent standardised patient history, clinical and MRI examinations within 5 days, and time to RTS was registered. A general linear model was constructed to assess the associations between RTS and the potential baseline predictors. A manual backward stepwise technique was used to keep treatment variables fixed.

Results In the first multiple regression model including only patient history and clinical examination, maximum pain score (visual analogue scale, VAS), forced to stop within 5 min, length of hamstring tenderness and painful resisted knee flexion (90°), showed independent associations with RTS and the final model explained 29% of the total variance in time to RTS. By adding MRI variables in the second multiple regression model, maximum pain score (VAS), forced to stop within 5 min, length of hamstring tenderness and overall radiological grading, showed independent associations and the adjusted R² increased from 0.290 to 0.318. Thus, additional MRI explained 2.8% of the variance in RTS.

Summary There was a wide variation in time to RTS and the additional predictive value of MRI was negligible compared with baseline patient history taking and clinical examinations alone. Thus, clinicians cannot provide an accurate time to RTS just after an acute hamstring injury. This study provides no rationale for routine MRI after acute hamstring injury.

Trial registration number ClinicalTrials.gov Identifier: NCT01812564.