Abstract
ObjectivesPrevious studies have shown low to moderate evidence for a variety of magnetic resonance imaging (MRI) features as prognostic factors in athletes with hamstring injuries. Short-tau inversion recovery (STIR) signal intensity has not yet been investigated for assessing the prognosis of acute muscle injuries. Our aim was to explore the relationship between MRI STIR signal intensity and time to return to play (RTP) and to investigate the association between MRI STIR and reinjury risk in athletes with acute hamstring injuries. Study designCase-control study. MethodsWe used MRI STIR to measure intramuscular signal intensity in patients with clinically diagnosed hamstring injuries at two time points: at injury and RTP. At injury, we calculated the association of MRI STIR signal intensity with the time to RTP and reinjury risk. At RTP, the association of MRI STIR signal intensity and reinjury risk and the change in MRI STIR signal intensity over time on reinjury risk was evaluated. Results51 patients were included. We found increased MRI STIR signal intensity: (1) at time of injury not to be associated with time to RTP, (2) at time of injury to be associated with a slightly lower risk for reinjury: odds 0.986 (0.975–0.998, p=0.02) and (3) at RTP not to be associated with reinjury risk. (4) We found no association between the change in MRI STIR signal intensity over time and reinjury risk. ConclusionIncreased MRI STIR signal intensity at injury has no value in time to RTP prognosis, but is associated with a reduced reinjury risk.
Highlights
We found increased magnetic resonance imaging (MRI) Short-tau inversion recovery (STIR) signal intensity: (1) at time of injury not to be associated with time to return to play (RTP), (2) at time of injury to be associated with a slightly lower risk for reinjury: odds 0.986 (0.975–0.998, p = 0.02) and (3) at RTP not to be associated with reinjury risk
In the original study 6 of 80 patients did not complete the 1 year follow-up, 4 were censored as they sustained another injury before they returned to play. 1 patient was lost to follow-up after RTP and 1 patient did not return to play within the study period
In summary this is the first study to investigate the value of intra-muscular signal intensity on time to RTP prognosis and reinjury risk estimation after acute hamstring injury
Summary
A potentially relevant MRI feature that has not yet been investigated is the signal intensity on fluid sensitive sequences and their changes over time. The use of fluid sensitive sequences is not new in HSI research.[10,12] Some lesions may appear brighter white to clinicians than other lesions, the brightness (i.e. signal intensity) can be measured on fluid sensitive sequences. We hypothesized that the extent of increased signal intensity on fluid sensitive sequences is associated with a longer period until RTP and an increased reinjury risk
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