Location of Hamstring Injuries Based on Magnetic Resonance Imaging: A Systematic Review

Abstract

Context: Hamstring muscle injury location using magnetic resonance imaging (MRI) is not so well described in the literature. Objective: To describe the location of hamstring injuries using MRI. Data Sources: PubMed, Web of Science, Scopus, SPORTDiscus, Cochrane Library. Study Selection: The full text of studies, in English, had to be available. Case reports and reviews were excluded. Included studies must report the location of hamstring injuries using MRI within 8 days of the acute injury. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: A first screening was conducted based on title and abstract of the articles. In the second screening, the full text of the remaining articles was evaluated for the fulfillment of the inclusion criteria. Results: From the 2788 references initially found in 5 databases, we included 34 studies, reporting a total of 2761 acute hamstring injuries. The most frequent muscle head involved was the long head of the biceps femoris (BFLH) (70%), followed by the semitendinosus (ST) (15%), generally associated with BFLH. The most frequent tissue affected was the myotendinous junction (MTJ) accounting for half the cases (52%). Among all lesions, the distribution between proximal, central, and distal lesions looked homogenous, with 34.0%, 33.4% and 32.6%, respectively. The stretching mechanism, while only reported in 2 articles, represented 3% of all reported mechanisms, appears responsible for a specific lesion involving the proximal tendon of the semimembranosus (SM), and leading to a longer time out from sport. Conclusion: BFLH was the most often affected hamstring injuries and MTJ was the most affected tissue. In addition, the distal, central, and proximal locations were homogeneously distributed. We also noted that MRI descriptions of hamstring injuries are often poor and did not take full advantage of the MRI strengths. Systematic Review Registration: Before study initiation, the study was registered in the PROSPERO International prospective register of systematic reviews (registration number CRD42018107580).

Hamstring Injuries: A Current Concepts Review: Evaluation, Nonoperative Treatment, and Surgical Decision Making

“…45 Of the 3 hamstring muscles, the biceps femoris is most commonly injured, accounting for 57% to 87% of all hamstring strains occurring at the proximal or distal musculotendinous junction. 34,45,56,67,105 These injuries typically occur in sports involving rapid, explosive acceleration, such as soccer, track and field, football, gymnastics, rugby, and water skiing. 3,5,23 Among these sports, professional soccer has the highest injury rate, affecting 20% of athletes per season.…”

“…57,64,105 However, a systematic review of magnetic resonance imaging (MRI) scans of hamstring locations found a homogeneous distribution among proximal, central, and distal lesions. 45 Of the 3 hamstring muscles, the biceps femoris is most commonly injured, accounting for 57% to 87% of all hamstring strains occurring at the proximal or distal musculotendinous junction. 34,45,56,67,105 These injuries typically occur in sports involving rapid, explosive acceleration, such as soccer, track and field, football, gymnastics, rugby, and water skiing.…”

“…Multiple classification systems are available to describe hamstring injuries, but these systems are used inconsistently throughout the literature. 23,45 Commonly, these injuries are described in terms of the severity of the injury, which can be based on physical examination, ultrasonography, or MRI findings. Peetrons 82 developed an ultrasound-based classification system frequently used to describe muscle and tendon injuries, including hamstring tears.…”

Distinct myofibre domains of the human myotendinous junction revealed by single nucleus RNA-seq

“…The main portion of the myofibre contains thousands of myonuclei, each believed to manage their own domain, but under a common transcriptional programme, to provide mRNA for the major structural and metabolic functions of the myofibre. While the NMJ has received extensive attention, much less focus has been directed to the MTJ, although this myofibre domain is selectively affected in different pathological clinical conditions, from muscle strain injuries (Grange et al 2022) to muscular dystrophies (Chemello et al 2020). Interestingly, in mice with skeletal muscle-specific disruption of dystroglycan, dystroglycan staining was curiously preserved in the sarcolemma at the NMJ and MTJ (Cohn et al 2002), further supporting the notion of segregated domains in the myofibre.…”

Fibre type differences in the organisation of mononuclear cells and myonuclei at the tips of human myofibres

“…The expansion of the COL22A1 + tenocyte population following injury (Scott et al, 2019) favours the idea of a regenerative role for these cells. However, the sheer number of MTJ cells we observed here does not align well with the high susceptibility of the MTJ to injury and the poor regenerative capacity (Grange et al, 2023; Wangensteen et al, 2016), potentially indicating the need for alternative rehabilitation strategies to provide an optimal environment for activity of these cells to improve repair outcomes.…”