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Am J Sports Med. 2016 Aug;44(8):2112-21. doi: 10.1177/0363546516646086. Epub 2016 May 16.

Hamstring Reinjuries Occur at the Same Location and Early After Return to Sport: A Descriptive Study of MRI-Confirmed Reinjuries.

Author information

1
Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway arnlaug.wangensteen@aspetar.com.
2
Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Amsterdam Center for Evidence Based Medicine, Academic Medical Center, Amsterdam, the Netherlands.
3
Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department Rehabilitation Science and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
4
Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
5
Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar High Performance Sport NZ, Sport Research Institute of New Zealand, Millennium Institute of Sport and Health, Mairangi Bay, Auckland, New Zealand.
6
Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.

Abstract

BACKGROUND:

Despite relatively high reinjury rates after acute hamstring injuries, there is a lack of detailed knowledge about where and when hamstring reinjuries occur, and studies including imaging-confirmed reinjuries are scarce.

PURPOSE:

To investigate the location, radiological severity, and timing of reinjuries on magnetic resonance imaging (MRI) compared with the index injury.

STUDY DESIGN:

Case series; Level of evidence, 4.

METHODS:

A MRI scan was obtained ≤5 days after an acute hamstring index injury in 180 athletes, and time to return to sport (RTS) was registered. Athletes with an MRI-confirmed reinjury in the same leg ≤365 days after RTS were included. Categorical grading and standardized MRI parameters of the index injury and reinjury were scored by a single radiologist (with excellent intraobserver reliability). To determine the location of the reinjury, axial and coronal views of the index injury and reinjury were directly compared on proton density-weighted fat-suppressed images.

RESULTS:

In the 19 athletes included with reinjury, 79% of these reinjuries occurred in the same location within the muscle as the index injury. The median time to RTS after the index injury was 19 days (range, 5-37 days; interquartile range [IQR], 15 days). The median time between the index injury and reinjury was 60 days (range, 20-316 days; IQR, 131 days) and the median time between RTS after the index injury and the reinjury was 24 days (range, 4-311 days; IQR, 140 days). More than 50% of reinjuries occurred within 25 days (4 weeks) after RTS from the index injury and 50% occurred within 50 days after the index injury. All reinjuries with more severe radiological grading occurred in the same location as the index injury.

CONCLUSION:

The majority of the hamstring reinjuries occurred in the same location as the index injury, early after RTS and with a radiologically greater extent, suggesting incomplete biological and/or functional healing of the index injury. Specific exercise programs focusing on reinjury prevention initiated after RTS from the index injury are highly recommended.

KEYWORDS:

hamstring injury; location; magnetic resonance imaging; reinjury; return to sport

PMID:
27184543
DOI:
10.1177/0363546516646086
[Indexed for MEDLINE]

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