Intratendinous hamstring injuries: sequential MRIs as a tool to reduce the risk of reinjury in elite sport

Review written by Adam Johnson info

Key Points

  1. Sequential imaging of an intramuscular hamstring tendon following significant injury appears to demonstrate that the tendon develops greater cross-sectional area as a strategy to cope with the demands placed upon it.
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BACKGROUND & OBJECTIVE

Ever since the publication of the British Athletics Muscle Injury Classification system (BAMIC) there has been more interest in the true implications of an intramuscular tendon injury on both time loss and risk of reinjury (1). Since publication there has been disagreement as to whether or not involvement of the intramuscular tendon is a poor prognostic factor for footballers. Brukner and Connell discussed the potential issues arising from intramuscular tendon involvement within their review piece (2). Their discussion surrounding a poor prognosis with the ‘c type’ injury was subsequently reinforced by retrospective studies (3).

A later prospective study contradicted these findings though and reported no statistically significant difference in time loss or risk of reinjury in a cohort of amateur footballers (4). The conflicting evidence may however be explained by the different cohorts within which the research took place, with track athletes and elite footballers placing more demands on the structures than those in an amateur football setting.

Due to the concerns surrounding the potential risk of greater time loss and risk of reinjury, there is a desire to further research rehabilitation processes to help successfully and safely return players with these injuries to competitive action.

There has been disagreement as to whether or not involvement of the intramuscular tendon is a poor prognostic factor for footballers.
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This paper gives us a greater understanding and respect for the true time taken for these structures to heal and remodel.

METHODS

This paper utilized three cases of acute hamstring injuries sustained within a Premier League football club. All three cases underwent MRI imaging 24 hours after the injury was sustained to obtain a definitive radiological classification of injury in line with

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