Magnetic Resonance Imaging in Acute Hamstring Injury: Can We Provide a Return to Play Prognosis?

Background Sports physicians are increasingly requested to perform magnetic resonance imaging (MRI) of acute hamstring muscle injuries and to provide a prognosis of the time to return to play (RTP) on the basis of their findings. Objectives To systematically review the literature on the prognostic value of MRI findings for time to RTP in acute hamstring muscle injuries. Data Sources The databases of PubMed, EMBASE, CI-NAHL, Web of Science and Cochrane Library were searched in June 2013. Study Eligibility Criteria Studies evaluating MRI as a prognostic tool for determining time to RTP in athletes with acute hamstring injuries were eligible for inclusion. Data Analysis Two authors independently screened the search results and assessed risk of bias using criteria for quality appraisal of prognosis studies. A best-evidence synthesis was used to identify the level of evidence. Results Of the 12 studies included, one had a low risk of bias and 11 a high risk of bias. There is moderate evidence that injuries without hyperintensity on fluid-sensitive sequences are associated with a shorter time to RTP and that injuries involving the proximal free tendon are associated with a longer time to RTP. Limited evidence was found for an association of central tendon disruption, injury not affecting the musculotendinous junction and a total rupture with a longer time to RTP. The other MRI findings studied showed either no association or there was conflicting evidence. Conclusion There is currently no strong evidence for any MRI finding that gives a prognosis on the time to RTP after an acute hamstring injury, owing to considerable risks of bias in the studies on this topic.