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London International Consensus and Delphi study on hamstring injuries part 1: classification.

Bruce M Paton1,2,3, Nick Court4, Michael Giakoumis5

  • 1Institute of Sport Exercise and Health, University College London, London, UK b.paton@ucl.ac.uk.

British Journal of Sports Medicine
|January 17, 2023
PubMed
Summary

Current hamstring injury classification systems need improvement. Experts recommend integrating imaging and clinical data for better diagnosis, management, and prognosis of hamstring injuries.

Keywords:
consensusdiagnosishamstring musclesrehabilitationsurgical procedures, operative

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Area of Science:

  • Sports Medicine
  • Musculoskeletal Imaging
  • Rehabilitation Science

Background:

  • Existing hamstring injury classification systems lack reliability and validity.
  • Current systems are not specific to individual hamstring muscles, potentially impacting sport-specific decision-making.
  • There is a need for advanced classification systems that incorporate imaging and clinical parameters.

Purpose of the Study:

  • To achieve international consensus on best-practice decision-making for hamstring injury classification.
  • To identify key parameters for evolving hamstring injury classification systems.
  • To address limitations in current diagnostic and prognostic tools for hamstring injuries.

Main Methods:

  • A narrative evidence review was conducted.
  • A modified Delphi study involving international experts (sports medicine physicians, physiotherapists, surgeons, trainers, sports scientists) was employed.
  • Consensus was built through digital surveys and a face-to-face meeting.

Main Results:

  • The British Athletics Muscle Injury Classification (BAMIC) is the most commonly used system (58%).
  • Identified issues include detailing individual hamstring muscles, optimizing imaging use, and testing validity/reliability.
  • Consensus recommends integrating imaging, clinical parameters, injury mechanism, sporting demand, functional criteria, and patient-reported outcomes.

Conclusions:

  • Hamstring injury classification systems require evolution to enhance diagnostic accuracy and prognostic value.
  • Future systems should be more specific, incorporating individual muscle details and functional outcomes.
  • Further research is needed on surgical referral criteria and the validity/reliability of classification systems.