Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play

Review written by Dr Teddy Willsey info

Key Points

  1. The presence of hamstring intramuscular tendon discontinuity does not indicate a lack of readiness for return to play.
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BACKGROUND & OBJECTIVE

Hamstring strains are one of the most common contractile tissue injuries seen in sports that involve rapid acceleration, high velocity sprinting, and change of direction (1). The significance of injury specifically to the hamstring intramuscular tendon is a controversial and not well understood topic. The hamstring’s central intramuscular tendon is defined as the part of the tendon to which muscle fibers attach.

Previous research has suggested hamstring injury with involvement of the central tendon led to longer return to play (RTP) times and warranted surgical consultation. Despite this early understanding, more recent research has been unable to show intramuscular tendon involvement to be a strong predictive factor for return to play time or reinjury rate (2). Moreover, injuries that involve the intramuscular tendon are variable, do not all present with the same degree of severity, and tend to respond well to conservative treatment (1).

The purpose of this study was to describe MRI characteristics of the intramuscular tendon at RTP, track the healing of the intramuscular tendon from baseline to RTP, and examine the relationship between healing on MRI and reinjury versus successful RTP.

The hamstring’s central intramuscular tendon is defined as the part of the tendon to which muscle fibers attach.
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This study brings into question the utility of MRI in helping to determine return to sport readiness.

METHODS

The authors used data from two separate randomized controlled trials that both investigated the efficacy of platelet-rich plasma (PRP) treatments for acute hamstring injuries. Both trials used MRI within 5 days of the injury, and then again within 7 days

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