MR imaging of the distribution and location of acute hamstring injuries in athletes

OBJECTIVE. Although hamstring injuries are common in athletes, the distribution and location of such injuries have not been well defined. We used MR imaging to determine the frequency of injury by muscle, involvement of one or more muscles, and location of injuries within the musculotendinous unit. SUBJECTS AND METHODS. We performed MR imaging on 15 consecutive college athletes with clinically diagnosed acute hamstring injuries. A hamstring injury was diagnosed and located on MR imaging by identifying high signal intensity within the muscle on T2-weighted images. RESULTS. We found that 10 athletes had injuries of a single muscle with six injuries of the biceps femoris, three of the semitendinosus, and one of the semimembranosus. In an additional five athletes, we found primary injuries of the biceps femoris and secondary injuries of the semitendinosus. The injuries occurred in diverse locations within the muscles including five injuries at the proximal musculotendinous junction, two at the distal musculotendinous junction, four within the proximal half of the muscle belly, and four in the distal half. All eight intramuscular injuries were located at the musculotendinous junction within the muscle. CONCLUSION. The biceps femoris is the most commonly injured hamstring muscle and the semitendinosus is the second most commonly injured. Although hamstring injuries often involve one muscle injured proximally, multiple muscles were involved in 33% of athletes (5/15) and the injuries were distal in 40% of athletes (6/15). All intramuscular injuries occurred at the musculotendinous junction, either at the ends of the muscle or within the muscle belly.