Arnlaug Wangensteen1, Johannes L Tol2, Erik Witvrouw3, Robbart Van Linschoten4, Emad Almusa4, Bruce Hamilton5, Roald Bahr6. 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.
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.
Authors: Matthew Buckthorpe; Furio Danelon; Giovanni La Rosa; Gianni Nanni; Matthew Stride; Francesco Della Villa Journal: Sports Med Date: 2020-12-17 Impact factor: 11.136
Authors: Robin Vermeulen; Rod Whiteley; Anne D van der Made; Nicol van Dyk; Emad Almusa; Celeste Geertsema; Stephen Targett; Abdulaziz Farooq; Roald Bahr; Johannes L Tol; Arnlaug Wangensteen Journal: Br J Sports Med Date: 2022-03-25 Impact factor: 18.473