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Information about a piece of news titled MRI does not add value over and above patient history and clinical examination in predicting time to RTS after acute hamstring injuries

MRI does not add value over and above patient history and clinical examination in predicting time to RTS after acute hamstring injuries


A recently published study including 180 male athletes concluded that the additional value of MRI for predicting time to return to sport (RTS) after acute hamstring injuries was negligible, compared to baseline patient history and clinical examinations alone.

The prospective study was performed at Aspetar Orthopaedic and Sports Medicine Hospital in Doha, Qatar, and is part of a larger project led by PhD-student at the Oslo Sports Trauma Research Center, Arnlaug Wangensteen.

Is MRI necessary after acute hamstring injuries?

Acute hamstring injury is one of the most common non-contact muscle injury in football and other sports with high-speed running involved. The use of expensive MRI investigations after these injuries have increased extensively the last decade and medical staff is frequently asked to provide prognosis for when the athlete can return to sports participation based on initial MRI findings.

However, whether MRI can accurately provide an estimate for RTS is debated, and the evidence is conflicting.

The aim of this study was therefore to investigate the predictive value of patient history and clinical examinations alone for time to RTS, and the additional predictive value of MRI findings.

Prospective cohort from 2011-14

The athletes presenting with clinical diagnosis of acute hamstring injury between January 2011 and June 2014 underwent standardized patient history, clinical- and MRI examinations within 5 days after injury. We registered time to RTS and developted sophisticated statistical models to determine the value of an anamnese, clinical evaluation, and MR scans in the prediction of time to RTS.

The additional value of MRI was only 2.8%

- In the first model, we included patient history and clinical examinations, and these explained 29% of the total variance in time to RTS, PhD-student Arnlaug Wangensteen (picture below) says.  

- When we added MRI variables to our model, the total variance increased to 31.8%. In other words, MRI examinations did not add more than 3% to the prediction model compared to anamnese and clinical examination alone.

Focusing on clinical evaluation, not on MRI

Based on our findings, there is no rationale for routine MRI after acute hamstring injuries. MRI will not give a more accurate RTS estimate beyond the findings from the baseline patient history and clinical examinations.

- In general, we therefore suggest focusing on clinical evaluation, and think this is an important message for physicians and physiotherapies treating athletes with acute hamstring injuries, and not at least for the athletes themselves and their coaches, Arnlaug adds.

Baseline examinations not enough to provide an accurate RTS estimation?

With a large proportion of unknown factors involved, we also found that baseline patient history and clinical examinations neither provided a very precise estimation for RTS (only 29%). Also, we saw a wide individual variation in days to RTS. This suggests that the clinician cannot give a clear answer at the first appointment about when the athlete will be ready for RTS.

However, it is important to stress that, as with managing all kind of injuries, individual considerations should be made. If there is suspicion of a total rupture/avulsion, MRI might be indicated for confirmation. 

Read the article in British Journal of Sports Medicine.