Time to return to full training is delayed and recurrence rate is higher in intratendinous (‘c’) acute hamstring injury in elite track and field athletes: clinical application of the British Athletics Muscle Injury Classification

Abstract

This study describes the clinical application of the British Athletics Muscle Injury Classification. Different categories of hamstring injuries had different TRFT and recurrence rate. Hamstring injuries that extend into the tendon ('c') are more prone to re-injury and delay TRFT.

Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury

“…In these groups, we have found a mean time to RTP of 28 and 22 days. Pollock et al 7 investigated hamstring injuries in track and field athletes and presented separate data for different grades with tendon involvement. They reported a mean TRFT of up to 84 days.…”

“…Moreover, 25% of the central tendon injuries were surgically repaired. Pollock et al 7 retrospectively analysed outcome for track and field athletes with injuries graded according to the British Athletics Muscle Injury Classification 6. Compared with myofascial or musculotendinous injury, the 15 intratendinous injuries took significantly longer to return to full training and had a reinjury rate of up to 63%.…”

The prognostic value of MRI in determining reinjury risk following acute hamstring injury: a systematic review

“…Therefore it is questionable if these exacerbations of symptoms should be regarded as a re-injury or require another definition. Additional analysis by Pollock et al ,15 after communication with them, and with exclusion of these cases with exacerbations of symptoms instead of a ‘real’ re-injury, still showed a statistically significant association for classification according to the British Muscle Injury Classification and intratendinous injuries with re-injury. In the study of Silder et al ,18 only two of the four described re-injuries were ‘real’ re-injuries after RTP.…”

“…There was no statistically significant difference in the number of lesions located at the musculotendinous junction, myofascial, mixed, tendon-bone and proximal tendon between these groups. Pollock et al 15 categorised the injury location as proximal, central and distal injuries and they did not find an association between this classification and re-injury.…”

“…Pollock et al 15 reported a statistically significant association with hamstring re-injury for both grading according to the British Muscle Injury Classification and intratendinous injuries identified on MRI. Involvement of the tendon, however, was a part of the above grading system, so hamstring injuries that extended into the tendon (grade ‘c’ in the grading system) were more prone to hamstring re-injury.…”