Crema Michel D, Guermazi Ali, Reurink Gustaaf, Roemer Frank W, Maas Mario, Weir Adam, Moen Maarten H, Goudswaard Gert J, Tol Johannes L
Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA.
Department of Radiology, Saint-Antoine Hospital, Paris VI University, Paris, France.
Orthop J Sports Med. 2017 Oct 26;5(10):2325967117733434. doi: 10.1177/2325967117733434. eCollection 2017 Oct.
Involvement of the intramuscular (central) tendon in acute hamstring injuries, as detected on magnetic resonance imaging (MRI), may prolong recovery times. To date, it is unclear whether hamstring injuries exhibiting intramuscular tendon involvement can be identified though routine clinical examinations that assess flexibility and strength.
To test whether MRI-detected intramuscular tendon involvement could be identified by a clinical assessment of muscle strength and flexibility.
Case-control study; Level of evidence, 3.
Participants were drawn from a multicenter randomized controlled trial on the effect of platelet-rich plasma in acute hamstring injuries. Clinical parameters assessed within 5 days of injury were active knee extension and passive straight-leg raise for hamstring flexibility and isometric knee flexion force with 15° and 90° of knee flexion. Also, 1.5-T MRI of the thigh was performed within 5 days of injury and was evaluated for the presence of different types of intramuscular tendon involvement. One-way analysis of variance was used to determine whether clinical parameters could discriminate injuries with intramuscular tendon involvement from those without such involvement.
A total of 74 acute hamstring injuries were included, with 52 (70.3%) injuries affecting the myotendinous junction. Injuries exhibiting intramuscular tendon discontinuity on MRI had an increased mean absolute flexibility deficit for active knee extension (20.4° ± 14.9° vs 10.7° ± 9.0°, respectively; = .006) and decreased mean strength at 15° (62.2 ± 26.7 N vs 76.6 ± 22.5 N, respectively; = .05) compared with injuries without intramuscular tendon discontinuity. Flexibility and strength showed major overlap and variance among injuries with and without intramuscular tendon involvement.
Hamstring flexibility and strength cannot be used to discriminate the presence of intramuscular tendon involvement.
磁共振成像（MRI）检测发现，急性腘绳肌损伤累及肌内（中央）肌腱可能会延长恢复时间。迄今为止，尚不清楚通过评估柔韧性和力量的常规临床检查能否识别出累及肌内肌腱的腘绳肌损伤。
测试通过临床评估肌肉力量和柔韧性能否识别出MRI检测到的肌内肌腱受累情况。
病例对照研究；证据等级，3级。
参与者来自一项关于富血小板血浆对急性腘绳肌损伤影响的多中心随机对照试验。在受伤后5天内评估的临床参数包括：主动膝关节伸展和被动直腿抬高以评估腘绳肌柔韧性，以及在膝关节屈曲15°和90°时的等长屈膝力量。此外，在受伤后5天内对大腿进行1.5-T MRI检查，并评估不同类型肌内肌腱受累情况。采用单因素方差分析来确定临床参数能否区分累及肌内肌腱的损伤和未累及的损伤。
共纳入74例急性腘绳肌损伤，其中52例（70.3%）损伤累及肌腱结合部。与未出现肌内肌腱连续性中断的损伤相比，MRI显示肌内肌腱连续性中断的损伤在主动膝关节伸展时平均绝对柔韧性 deficit增加（分别为20.4°±14.9°和10.7°±9.0°；P =.006），在15°时平均力量降低（分别为62.2±26.7 N和76.6±22.5 N；P =.05）。在累及和未累及肌内肌腱的损伤中，柔韧性和力量存在较大重叠和差异。
腘绳肌的柔韧性和力量不能用于区分肌内肌腱受累情况。
