Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
Faculty of Sports Science, Universitas Negeri Yogyakarta, Yogyakarta, Special Region of Yogyakarta, Indonesia.
Br J Sports Med. 2024 Jul 1;58(14):766-776. doi: 10.1136/bjsports-2023-107878.
Studies identifying clinical and MRI reinjury risk factors are limited by relatively small sample sizes. This study aimed to examine the association between baseline clinical and MRI findings with the incidence of hamstring reinjuries using a large multicentre dataset.
We merged data from four prospective studies (three randomised controlled trials and one ongoing prospective case series) from Qatar and the Netherlands. Inclusion criteria included patients with MRI-confirmed acute hamstring injuries (<7 days). We performed multivariable modified Poisson regression analysis to assess the association of baseline clinical and MRI data with hamstring reinjury incidence within 2 months and 12 months of follow-up.
330 and 308 patients were included in 2 months (31 (9%) reinjuries) and 12 months (52 (17%) reinjuries) analyses, respectively. In the 2-month analysis, the presence of discomfort during the active knee extension test was associated with reinjury risk (adjusted risk ratio (ARR) 3.38; 95% CI 1.19 to 9.64). In the 12 months analysis, the time to return to play (RTP) (ARR 0.99; 95% CI 0.97 to 1.00), straight leg raise angle on the injured leg (ARR 0.98; 95% CI 0.96 to 1.00), the presence of discomfort during active knee extension test (ARR 2.52; 95% CI 1.10 to 5.78), the extent of oedema anteroposterior on MRI (ARR 0.74; 95% CI 0.57 to 0.96) and myotendinous junction (MTJ) involvement on MRI (ARR 3.10; 95% CI 1.39 to 6.93) were independently associated with hamstring reinjury.
Two clinical findings (the presence of discomfort during active knee extension test, lower straight leg raise angle on the injured leg), two MRI findings (less anteroposterior oedema, MTJ involvement) and shorter time to RTP were independently associated with increased hamstring reinjury risk. These findings may assist the clinician to identify patients at increased reinjury risk following acute hamstring injury.
NCT01812564; NCT02104258; NL2643; NL55671.018.16.
确定临床和 MRI 再损伤危险因素的研究受到样本量相对较小的限制。本研究旨在使用大型多中心数据集，检查基线临床和 MRI 结果与腘绳肌再损伤发生率之间的关系。
我们合并了来自卡塔尔和荷兰的四项前瞻性研究（三项随机对照试验和一项正在进行的前瞻性病例系列）的数据。纳入标准包括 MRI 证实的急性腘绳肌损伤（<7 天）患者。我们进行多变量修正泊松回归分析，以评估基线临床和 MRI 数据与 2 个月和 12 个月随访期间腘绳肌再损伤发生率的关系。
分别有 330 名和 308 名患者进入 2 个月（31 例[9%]再损伤）和 12 个月（52 例[17%]再损伤）分析。在 2 个月分析中，主动膝关节伸展试验时出现不适与再损伤风险相关（校正风险比（ARR）3.38；95%置信区间 1.19 至 9.64）。在 12 个月分析中，重返运动时间（ARR 0.99；95%置信区间 0.97 至 1.00）、受伤腿直腿抬高角度（ARR 0.98；95%置信区间 0.96 至 1.00）、主动膝关节伸展试验时出现不适（ARR 2.52；95%置信区间 1.10 至 5.78）、MRI 上前后向肿胀程度（ARR 0.74；95%置信区间 0.57 至 0.96）和 MRI 上肌肌腱结合处（MTJ）受累（ARR 3.10；95%置信区间 1.39 至 6.93）与腘绳肌再损伤独立相关。
两个临床发现（主动膝关节伸展试验时出现不适，受伤腿直腿抬高角度较低）、两个 MRI 发现（前后向肿胀程度减轻，MTJ 受累）和较短的重返运动时间与腘绳肌再损伤风险增加独立相关。这些发现可能有助于临床医生识别急性腘绳肌损伤后再损伤风险增加的患者。
NCT01812564；NCT02104258；NL2643；NL55671.018.16。
