TY - JOUR
T1 - Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play
AU - Vermeulen, Robin
AU - Almusa, Emad
AU - Buckens, Stan
AU - Six, Willem
AU - Whiteley, Rod
AU - Reurink, Guus
AU - Weir, Adam
AU - Moen, Maarten
AU - Kerkhoffs, Gino M. M. J.
AU - Tol, Johannes L.
N1 - Funding Information: 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. Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - 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.
AB - 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.
KW - MRI
KW - hamstrings
KW - injury
KW - sports and exercise medicine
KW - tendon
UR - http://www.scopus.com/inward/record.url?scp=85087565527&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bjsports-2019-101808
DO - https://doi.org/10.1136/bjsports-2019-101808
M3 - Article
C2 - 32561516
SN - 0306-3674
VL - 55
SP - 397
EP - 402
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 7
M1 - bjsports-2019-101808
ER -