Hamstring Injuries in Professional Football Players

Abstract

Background:Magnetic resonance imaging (MRI) allows for detailed evaluation of hamstring injuries; however, there is no classification that allows prediction of return to play.Purpose:To correlate time for return to play in professional football players with MRI findings after acute hamstring strains and to create an MRI scoring scale predictive of return to sports.Study Design:Descriptive epidemiologic study.Methods:Thirty-eight professional football players (43 cases) sustained acute hamstring strains with MRI evaluation. Records were retrospectively reviewed, and MRIs were evaluated by 2 musculoskeletal radiologists, graded with a traditional radiologic grade, and scored with a new MRI score. Results were correlated with games missed.Results:Players missed 2.6 ± 3.1 games. Based on MRI, the hamstring injury involved the biceps femoris long head in 34 cases and the proximal and distal hamstrings in 25 and 22 cases, respectively. When < 50% of the muscle was involved, the average number of games missed was 1.8; if > 75%, then 3.2. Ten players had retraction, missing 5.5 games. By MRI, grade I injuries yielded an average of 1.1 missed games; grade II, 1.7; and grade III, 6.4. Players who missed 0 or 1 game had an MRI score of 8.2; 2 or 3 games, 11.1; and 4 or more games, 13.9.Conclusions:Rapid return to play (< 1 week) occurred with isolated long head of biceps femoris injures with < 50% of involvement and minimal perimuscular edema, correlating to grade I radiologic strain (MRI score < 10). Prolonged recovery (missing > 2 or 3 games) occurs with multiple muscle injury, injuries distal to musculotendinous junction, short head of biceps injury, > 75% involvement, retraction, circumferential edema, and grade III radiologic strain (MRI score > 15).Clinical Relevance:MRI grade and this new MRI score are useful in determining severity of injury and games missed—and, ideally, predicting time missed from sports.

Return to Play After Soleus Muscle Injuries

“…The injuries included in this study were classified according to the location of injury (longitudinal, transverse), the anteroposterior extent of the edema, and the extent of retraction, or gaps, observed on MRI. 10 Thus, subjective interpretations about the degrees of injury were avoided.…”

“…The parameters in the MRI examinations were evaluated for extension and location of edema, the volume of the lesion, cross-sectional area, and extent of retraction (gap) of the injury. 10 …”

Classification and grading of muscle injuries: a narrative review

“…In a novel approach, Cohen et al 76 evaluated hamstring injuries in 43 American football players, combining six radiological observations into a single injury score (see online supplementary table 1 for details). A combined score of greater than 10 points was found to have a worse prognosis.…”

Distal Semimembranosus Tendon Avulsions: Acute Surgical Repair in a Professional Rugby Player

“…28 They are the single largest cause of lost playing time in Australian football 20 and American football. 11 They are also the predominant injury responsible for a prolonged absence (>28 days) from playing soccer. 15 The incidence of hamstring injuries in rugby players is nearly twice that reported for soccer players.…”

“…11,15,20,28 The hamstring tendons are particularly vulnerable to injuries, as they cross 2 joints and have a high proportion of type 2 muscle fibers. 17 They act mainly as decelerators of the leg, and as they work eccentrically, they are prone to excessive force in the muscle-tendon unit.…”