Int J Sports Med 2021; 42(06): 537-543
DOI: 10.1055/a-1306-0618
Orthopedics & Biomechanics

Reliability of MRI in Acute Full-thickness Proximal Hamstring Tendon Avulsion in Clinical Practice

Willem R. Six
1  Department of Orthopaedic Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
,
Constantinus F. Buckens
2  Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
3  Department of Radiology, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
,
Johannes L. Tol
2  Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
4  Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
,
Frank F. Smithuis
2  Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
3  Department of Radiology, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
,
Mario Maas
2  Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
3  Department of Radiology, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
4  Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
,
Gino M. Kerkhoffs
1  Department of Orthopaedic Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
2  Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
4  Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
,
Anne D. van der Made
1  Department of Orthopaedic Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
2  Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
3  Department of Radiology, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
4  Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
› Author Affiliations

Abstract

In clinically suspected acute full-thickness proximal hamstring tendon avulsions, MRI is the gold standard for evaluating the extent of the injury. MRI variables such as full-thickness free tendon discontinuity, extent of tendon retraction (>20 mm), and continuity of the sacrotuberous ligament with the conjoint tendon (STL-CT) are used in treatment decision-making. The objective was to assess the intra- and inter-rater reliability of these relevant MRI variables after acute full-thickness proximal hamstring tendon avulsion. Three musculoskeletal radiologists assessed MRIs of 40 patients with an acute full-thickness proximal hamstring tendon avulsion. MRI variables included assessment of free tendon discontinuity and continuity of the STL-CT and extent of tendon retraction. Absolute and relative intra- and inter-rater reliability were calculated. Intra- and inter-rater reliability for the assessment of tendon discontinuity was substantial (Kappa [ĸ]=0.78;0.77). For the retraction measurement of the conjoint and semimembranosus tendons, intra-rater reliability was moderate and poor (Intraclass correlation coefficient (ICC)=0.74;0.45), inter-rater reliability was moderate (ICC=0.73;0.57). Intra- and inter-rater reliability of the STL-CT continuity assessment was substantial and fair (ĸ=0.74;0.31). In conclusion, MRI assessment for full-thickness free tendon discontinuity is reliable. However, assessment of extent of tendon retraction and STL-CT continuity is not reliable enough to guide the treatment decision-making process.



Publication History

Received: 09 March 2020

Accepted: 27 October 2020

Publication Date:
15 December 2020 (online)

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