Temporal MRI appearance of postoperative healing after proximal hamstring musculotendinous complex repair
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Published on: January 13, 2026
Sandra Mechó1,2,3, Pamela Pérez4, Alejandro Congo5
1FC Barcelona Medical Department (FIFA Medical Center of Excellence), and Barça Innovation Hub, Health & Wellness Area, Barcelona, Spain. mechomeca@gmail.com.
Objective:
To describe the temporal MRI features of healing during the first 4 months following surgical repair of complete tears of the proximal hamstring musculotendinous complex.
Materials And Methods:
Consecutive case series. Professional football players with MRI-confirmed complete tears surgically repaired between May 2017 and December 2025 were retrospectively identified. Postoperative MRI examinations were obtained during routine clinical follow-up using 3-T systems. Two musculoskeletal radiologists independently evaluated longitudinal and transverse intratendinous clefts, scar maturation, edema-like signal, postoperative subcutaneous soft-tissue signal change, tendinous angulation, blunt muscle outline, and denervation-like signal.
Results:
Twenty-four complete tears in 20 players underwent surgical repair. Fifteen tendons with an uncomplicated postoperative course comprised the primary descriptive cohort, yielding 43 MRI examinations. Longitudinal intratendinous clefts were observed in 11/15 (73.3%) of tendons, transverse intratendinous clefts in 13/15 (86.7%), postoperative subcutaneous soft-tissue signal change and tendinous angulation in 15/15 (100%), blunt muscle outline in 13/15 (86.7%), and denervation-like signal in 10/15 (66.7%). In the within-tendon analysis, longitudinal and transverse intratendinous clefts resolved by the last available MRI in 6/10 (60%) and 7/12 (58.3%) tendons, respectively. All 10 tendons with an initially immature scar progressed to a mature scar. Among six tendons with postoperative exacerbation, four showed extensive, prominent intratendinous clefts with marked PD-FS hyperintensity on the preceding MRI, associated with immature scar, intratendinous cavity, or persistent interstitial edema-like signal.
Conclusion:
Serial MRI demonstrated different temporal patterns of postoperative healing. Residual intratendinous clefts may coexist with a mature scar during tendon remodeling and do not necessarily indicate delayed healing.