Muhammad Ikhwan Zein, Milo J K. Mokkenstorm, Marco Cardinale, Louis Holtzhausen, Rod Whiteley, Maarten H. Moen, Guus Reurink, Johannes L. Tol, Emad Almusa, Roald Bahr, Sita M. A. Bierma-Zeinstra, Sirine Boukarroum, Stan Buckens, Hakim Chalabi, Cristiano Eirale, Abdulaziz Farooq, Martijn Froeling, Celeste Geertsema, Gert Jan Goudswaard, Bruce Hamilton, Melissa T. Hooijmans, Mario Maas, Jithsa R. Monte, Aart J. Nederveen, Jos Oudeman, Frank F. Smithuis, Gustav J. Strijkers, Jozef J. M. Suskens, Stephen Targett, Anne D. van der Made, Nicol van Dyk, Jan A. N. Verhaar, Robin Vermeulen, Arnlaug Wangensteen, Adam Weir
Objectives Studies identifying clinical and MRI reinjury risk factors are limited by relatively small sample sizes. This study aimed to examine the association between baseline clinical and MRI findings with the incidence of hamstring reinjuries using a large multicentre dataset. Methods We merged data from four prospective studies (three randomised controlled trials and one ongoing prospective case series) from Qatar and the Netherlands. Inclusion criteria included patients with MRI-confirmed acute hamstring injuries (<7 days). We performed multivariable modified Poisson regression analysis to assess the association of baseline clinical and MRI data with hamstring reinjury incidence within 2 months and 12 months of follow-up. Results 330 and 308 patients were included in 2 months (31 (9%) reinjuries) and 12 months (52 (17%) reinjuries) analyses, respectively. In the 2-month analysis, the presence of discomfort during the active knee extension test was associated with reinjury risk (adjusted risk ratio (ARR) 3.38; 95% CI 1.19 to 9.64). In the 12 months analysis, the time to return to play (RTP) (ARR 0.99; 95% CI 0.97 to 1.00), straight leg raise angle on the injured leg (ARR 0.98; 95% CI 0.96 to 1.00), the presence of discomfort during active knee extension test (ARR 2.52; 95% CI 1.10 to 5.78), the extent of oedema anteroposterior on MRI (ARR 0.74; 95% CI 0.57 to 0.96) and myotendinous junction (MTJ) involvement on MRI (ARR 3.10; 95% CI 1.39 to 6.93) were independently associated with hamstring reinjury. Conclusions Two clinical findings (the presence of discomfort during active knee extension test, lower straight leg raise angle on the injured leg), two MRI findings (less anteroposterior oedema, MTJ involvement) and shorter time to RTP were independently associated with increased hamstring reinjury risk. These findings may assist the clinician to identify patients at increased reinjury risk following acute hamstring injury. © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, AMC, Amsterdam, Netherlands; Faculty of Sports Science, Universitas Negeri Yogyakarta, Special Region of Yogyakarta, Yogyakarta, Indonesia; Amsterdam Movement Sciences, Amsterdam, Netherlands; Aspetar Orthopaedic and Sports Medicine Hospital, Ad Dawhah, Doha, Qatar; Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Sports Medicine, Bergman Clinics BV, Naarden, Netherlands; Amsterdam Movement Sciences (AMS), Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC Location AMC, Amsterdam, Netherlands; Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Doha, Qatar; Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center, Doha, Qatar; Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Doha, Qatar; Director General for International Medical Affairs and Programs, Centers of Excellence, Aspetar, Orthopedic and Sports Medicine Hospital, Doha, Qatar; Paris Saint Germain Football Club, Doha, Qatar; Aspetar, Orthopedic and Sports Medicine Hospital, FIFA Medical Center of Excellence, Doha, Qatar; Department of Radiology, University Medical Center Utrecht, Netherlands; Department of Orthopedic and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Netherlands; Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Netherlands; Performance Health, High Performance Sports New Zealand, Sports Research Institute of New Zealand, Auckland University of Technology, New Zealand; Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Netherlands; High Performance Unit, Irish Rugby Football Union (IRFU), Dublin, Ireland; School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
