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Original article
Intramuscular tendon injury is not associated with an increased hamstring reinjury rate within 12 months after return to play
Anne D van der Made1,2,3,4, Emad Almusa1, Gustaaf Reurink2,3,5, Rod Whiteley1, Adam Weir1,6, Bruce Hamilton7, Mario Maas3,4,8, Aston S H Ngai1, Maarten H Moen5, Gert Jan Goudswaard1, Johannes L Tol1,3,4
Author affiliations
Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
Academic Center for Evidence-based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands
Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
The Sports Physicians Group, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
Erasmus MC Center for Groin Injuries, Department of Orthopaedics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
High Performance Sport New Zealand, Auckland, New Zealand
Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
Correspondence to Johannes L Tol, Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar; [email protected]
Abstract
Background Acute hamstring injury that includes intramuscular tendon injury has been suggested to be associated with increased reinjury risk. These observations were based on a relatively small number of retrospectively analysed cases.
Objective To determine whether intramuscular tendon injury is associated with higher reinjury rates in acute hamstring injury.
Methods MRIs of 165 athletes with an acute hamstring injury were obtained within 5 days of injury. Treatment consisted of a standardised criteria-based rehabilitation programme. Standardised MRI parameters and intramuscular tendon injury, the latter subdivided into tendon disruption and waviness, were scored. We prospectively recorded reinjuries, defined as acute onset of posterior thigh pain in the same leg within 12 months after return to play.
Results Participants were predominantly football players (72%). Sixty-four of 165 (39%) participants had an index injury with intramuscular hamstring tendon disruption, and waviness was present in 37 (22%). In total, there were 32 (19%) reinjuries. There was no significant difference (HR: 1.05, 95% CI 0.52 to 2.12, P=0.898) in reinjury rate between index injuries with intramuscular tendon disruption (n=13, 20%) and without tendon disruption (n=19, 20%). There was no significant difference in reinjury rate (X²(1)=0.031, P=0.861) between index injuries with presence of waviness (n=7, 19%) and without presence of waviness (n=25, 20%).
Conclusion In athletes with an acute hamstring injury, intramuscular tendon injury was not associated with an increased reinjury rate within 12 months after return to play.
