Arnlaug Wangensteen1, Emad Almusa2, Sirine Boukarroum2, Abdulaziz Farooq2, Bruce Hamilton3, Rodney Whiteley2, Roald Bahr1, Johannes L Tol4. 1. Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sports Science, Oslo, Norway. 2. Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. 3. Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar High Performance Sport NZ, Sport Research Institute of New Zealand; Millenium Institute of Sport and Health, Mairangi Bay, Auckland, New Zealand. 4. Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Amsterdam Center for Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Abstract
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 R(2) 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
RCT Entities:
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 R(2) 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Xavier Valle; Eduard Alentorn-Geli; Johannes L Tol; Bruce Hamilton; William E Garrett; Ricard Pruna; Lluís Til; Josep Antoni Gutierrez; Xavier Alomar; Ramón Balius; Nikos Malliaropoulos; Joan Carles Monllau; Rodney Whiteley; Erik Witvrouw; Kristian Samuelsson; Gil Rodas Journal: Sports Med Date: 2017-07 Impact factor: 11.136
Authors: Arnlaug Wangensteen; Ali Guermazi; Johannes L Tol; Frank W Roemer; Bruce Hamilton; Juan-Manuel Alonso; Rodney Whiteley; Roald Bahr Journal: Eur Radiol Date: 2018-02-19 Impact factor: 5.315
Authors: Andreas Serner; Frank W Roemer; Per Hölmich; Kristian Thorborg; Jingbo Niu; Adam Weir; Johannes L Tol; Ali Guermazi Journal: Eur Radiol Date: 2016-07-06 Impact factor: 5.315
Authors: Bruce Hamilton; Arnlaug Wangensteen; Rod Whiteley; Emad Almusa; Liesel Geertsema; Stephen Targett; Johannes L Tol Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-02-04 Impact factor: 4.342