Return to competitive play after hamstring injuries involving disruption of the central tendon.

BACKGROUND: The hamstring muscles are the most commonly injured muscle group in many different sports. Recovery time is often unpredictable and prolonged, and recurrent injury is common. HYPOTHESIS: Hamstring injuries that disrupt the central tendon enclosed within the muscle belly require a longer recovery time than do injuries involving only muscle, epimysial fascia, or the musculotendinous junction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Injury records from professional sports teams were reviewed to determine the length of recovery from each hamstring injury that occurred over a 24-month period. The integrity of the central tendon on magnetic resonance imaging (MRI) was retrospectively reviewed for each case. The association between central tendon disruption on MRI and recovery time was determined. RESULTS: There were 62 hamstring injuries included for analysis; 45 (72%) involved the biceps femoris, 11 (18%) involved the semimembranosus, and 6 (10%) involved the semitendinosus. Central tendon disruption was identified in 12 (45%) of the biceps femoris injuries and in none of the injuries to the other 2 muscles. Three of these injuries were treated surgically, with a median recovery time of 91 days. The median (interquartile range [IQR]) recovery times for those remaining biceps femoris injuries with and without central tendon disruption were 21 days (IQR, 9-28) and 72 days (IQR, 42-109), respectively (P < .01). CONCLUSION: Disruption of the central tendon in injuries to the biceps femoris results in a significantly longer recovery time than injuries that do not disrupt the central tendon. This highlights the distinction between injury to the hamstring muscle and injury to the hamstring tendon, which is underappreciated as being a distinct entity when injury involves the enclosed central portion of the tendon.

The match day use of ultrasound during professional football finals matches.

OBJECTIVES: To describe the use of ultrasound by a professional Australian rules football team in the immediate pregame period to guide local anaesthetic injections, during game time to assess injuries and to guide local anaesthetic injections, and postmatch to assess injuries and to guide therapeutic injections. METHODS: The use of match day ultrasound was documented during four finals matches. Local anaesthetic injections were considered effective if players played without pain and experienced no complication from the injection. The results of the diagnostic scans were assessed against subsequent clinical progress and correlation with any follow-up imaging. Therapeutic injections were considered effective if there was clinical improvement and the player was able to play in subsequent weeks without restriction. RESULTS: Pregame, a total of 11 ultrasound guided local anaesthetic injections were performed on eight players, with a further local anaesthetic during a game. All injections achieved good pain relief without any complication. A single diagnostic scan on one player during a game showed no acute muscle tear, the player successfully completed the game. Postgame, a total of four ultrasound guided steroid injections were performed on three players and all players played in the next match. The injections achieved good therapeutic results. The therapeutic injections given immediately postgame, maximised the recovery period available to the players. CONCLUSIONS: Ultrasound proved useful in guiding local anaesthetic before and during matches and also therapeutic injections after matches. Ultrasound had a limited role in the assessment of injuries during a game.