MRI findings prior to return to play as predictors of reinjury in professional athletes: a novel decision-making tool

Abstract

Background Because MRI has shown great accuracy in assessing acute muscle injuries, identification of risk factors for reinjury before return to play (RTP) in professional athletes during the healing process could be very relevant. We assessed the value of MRI findings prior to RTP as predictors of reinjury. Methods Retrospective observational study of 59 professional athletes, mean age 26 years, with first-time acute muscle injury and successful rehabilitation ready to RTP. They underwent MRI within 6 days of the injury and within 7 days prior to RTP. The primary outcome was reinjury. Risk of reinjury was assessed using radiological signs in control MRI scans before RTP. The risk was classified as low, medium or high when none, one or two radiological signs were observed, respectively. Results Reinjury occurred in 9 participants, with a rate of 15.2%. None of the baseline MRI-related variables was significantly associated with reinjury. In the control MRI scan performed within 7 days prior to RTP, three independent findings were significantly associated with reinjury. These included transversal and/or mixed connective tissue gap (p = 0.002), intermuscular oedema (p = 0.015) and callus gap (p = 0.046). In the predictive model of the risk of reinjury, the presence of two of these radiological signs, together with interstitial feathery oedema, was associated with a high risk of recurrence (OR 29.58, 95% CI 3.86–226.64; p = 0.001). Conclusions In professional athletes with acute muscle injuries of the lower limbs successfully rehabilitated, some radiological signs on MRI performed shortly before RTP were associated with a high risk of reinjury.

Intramuscular Tendon Injuries of the Hamstring Muscles: A More Severe Variant? A Narrative Review

“…This was due to a sizeable risk of bias in 11 of the 12 included studies. More recently, a retrospective analysis of 59 professional athletes showed that baseline MRI alone was not useful in predicting re-injury [ 51 ]. However, the baseline MRI findings were used to tailor the rehabilitation processes and later used for comparison with a further MRI before RTP clearance.…”

Return to Play in the Professional Athlete

“…28 The presence of intermuscular edema, increased callus gap, and increased connective tissue gap on MRI are also associated with a higher risk of reinjury. 29…”

Baseline clinical and MRI risk factors for hamstring reinjury showing the value of performing baseline MRI and delaying return to play: a multicentre, prospective cohort of 330 acute hamstring injuries

“…A study on MRI findings shortly prior to return to play (RTP) by Isern-Kebschull et al showed that the presence of two of these five radiological signs was associated with increased reinjury risk; connective tissue gap, loss of tendon tension, intermuscular oedema, callus gap and interstitial feather oedema. 12 A main limitation of the existing studies in the literature is that sample sizes of reinjuries are too small to detect possibly clinically relevant associations between clinical and imaging factors and reinjury risk. 9 11 About 30-50 reinjury cases are needed to detect a moderate to strong association between risk factors and reinjury risk, 13 and a multivariable analysis approach would require an even larger sample size.…”

“…However, there were several risks of bias from the studies included in these analyses, such as a lack of consistency in reinjury definition, heterogeneous risk factors and study methods, unrepresentative subjects and no adjustment for confounding factors. A study on MRI findings shortly prior to return to play (RTP) by Isern-Kebschull et al showed that the presence of two of these five radiological signs was associated with increased reinjury risk; connective tissue gap, loss of tendon tension, intermuscular oedema, callus gap and interstitial feather oedema 12…”