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Diffusion tensor imaging has prognostic value on return to play in hamstring injuries: A prospective cohort study.

Milo J K Mokkenstorm1, Jithsa R Monte2, Jozef J M Suskens3

  • 1Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Sports, Amsterdam, the Netherlands; AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands.

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Diffusion tensor imaging (DTI) parameters can help predict return to play (RTP) time after hamstring injuries. Radial diffusivity and fractional anisotropy showed the most added value for prognosis.

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Area of Science:

  • Sports Medicine
  • Radiology
  • Biomedical Engineering

Background:

  • Predicting return to play (RTP) after hamstring injuries is challenging.
  • Diffusion tensor imaging (DTI) can detect muscle micro-trauma, potentially improving RTP prediction.

Purpose of the Study:

  • To assess the predictive capability of DTI-derived metrics for RTP prognosis in athletes with hamstring injuries.
  • To determine the added value of DTI parameters compared to conventional MRI classifications.

Main Methods:

  • Prospective cohort study including athletes with acute hamstring injuries.
  • 3T MRI with DTI acquisition within 7 days of injury.
  • Calculation of DTI parameters (eigenvalues, mean diffusivity, radial diffusivity, fractional anisotropy) and correlation with self-reported RTP time using linear regression.

Main Results:

  • 91 athletes were analyzed, with a median RTP of 37 days.
  • All DTI parameters showed univariate associations with RTP time, explaining 5.4–15.0% of variance.
  • Multivariate analysis indicated independent associations between most DTI parameters and RTP time.

Conclusions:

  • DTI parameters are associated with RTP time after hamstring injury.
  • DTI parameters, particularly those reflecting radial diffusivity, offer significant added value for predicting RTP prognosis.