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Original research
Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play
  1. Robin Vermeulen1,2,
  2. Emad Almusa1,
  3. Stan Buckens3,
  4. Willem Six4,
  5. Rod Whiteley1,
  6. Guus Reurink2,5,
  7. Adam Weir1,6,
  8. Maarten Moen5,
  9. Gino M M J Kerkhoffs4,7,
  10. Johannes L Tol1,2
  1. 1Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2Academic Center of Evidence Based Sports Medicine, Amsterdam UMC—Locatie AMC, Amsterdam, North Holland, The Netherlands
  3. 3Department of Radiology, Amsterdam UMC—Locatie AMC, Amsterdam, North Holland, The Netherlands
  4. 4Department of Orthopaedic Surgery, Amsterdam UMC—Locatie AMC, Amsterdam, North Holland, The Netherlands
  5. 5Department of Sports Medicine, OLVG, Amsterdam, Noord-Holland, The Netherlands
  6. 6Center for Groin Injuries, Department of Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
  7. 7Amsterdam Collaboration for Health and Safety in Sports, Amsterdam, Netherlands
  1. Correspondence to Dr Robin Vermeulen, Research Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, 29222 Doha, Qatar; robin.vermeulen{at}aspetar.com

Abstract

Background Clinical decision-making around intramuscular tendon injuries of the hamstrings is a controversial topic in sports medicine. For this injury, MRI at return to play (RTP) might improve RTP decision-making; however, no studies have investigated this.

Objective Our objectives were to describe MRI characteristics at RTP, to evaluate healing and to examine the association of MRI characteristics at RTP with reinjury for clinically recovered hamstring intramuscular tendon injuries.

Methods We included 41 athletes with hamstring intramuscular tendon injuries and an MRI at baseline and RTP. For both MRIs, we used a standardised scoring form that included intramuscular tendon injury characteristics. We recorded reinjuries during 1-year follow-up.

Results At RTP, 56% of the intramuscular tendons showed a partial or complete thickness tendon discontinuity. Regarding healing from injury to RTP, 18 of 34 (44% overall) partial-thickness tendon discontinuities became continuous and 6 out of 7 (15% overall) complete thickness tendon discontinuities became partial-thickness tendon discontinuities. Waviness decreased from 61% to 12%, and 88% of tendons became thickened. We recorded eight (20%) reinjuries within 1 year. Intramuscular tendon characteristics at RTP between participants with or without a reinjury were similar.

Conclusion Complete resolution of an intramuscular tendon injury on MRI is not necessary for clinically successful RTP. From injury to RTP, the intramuscular tendon displayed signs of healing. Intramuscular tendon characteristics of those with or without a reinjury were similar.

  • hamstrings
  • injury
  • MRI
  • sports and exercise medicine
  • tendon

https://doi.org/10.1136/bjsports-2019-101808

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    Footnotes

    • Twitter @rbnvrmln, @RodWhiteley

    • Contributors RV was involved in the study design, data collection, analysis and interpretation of data and drafting of the manuscript. EA and SB were involved for evaluation of the MRI scans and drafting of the manuscript. WS was involved in data collection and drafting of the manuscript. RW, GR, AW, MM and GMMJK were involved in data interpretation and drafting of the manuscript. JLT was involved in study design, data interpretation and drafting of the manuscript.

    • Funding The Growth Factor study (Qatar) was internally funded by Aspetar. The Hamstring Injection Therapy (Dutch) study was supported by Arthrex Medizinische Instrumente GmbH and the Royal Dutch Football Association.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Internal Medical Ethics Board of Aspetar and Medical Ethics Committee of South-West Holland.

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

    • Data availability statement No data are available.