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

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.

Key words

discontinuity - inter-rater - avulsion - intra-ratera

• References

• 1 Van der Made AD, Hölmich P, Kerkhoffs GMMJ. et al. Proximal hamstring tendon avulsion treatment choice depends on a combination of clinical and imaging-related factors: A worldwide survey on current clinical practice and decision-making. J ISAKOS 2019; 4: 175-180
• 2 van der Made AD, Reurink G, Gouttebarge V. et al. Outcome after surgical repair of proximal hamstring avulsions: A systematic review. Am J Sports Med 2015; 43: 2841-2851
• 3 Bodendorfer BM, Curley AJ, Kotler JA. et al. Outcomes after operative and nonoperative treatment of proximal hamstring avulsions: A systematic review and meta-analysis. Am J Sports Med 2018; 46: 2798-2808
• 4 Cohen S, Bradley J. Acute proximal hamstring rupture. J Am Acad Orthop Surg 2007; 15: 350-355
• 5 Lempainen L. Surgical treatment of partial tears of the proximal origin of the hamstring muscles. Br J Sports Med 2006; 40: 688-691
• 6 Sarimo J, Lempainen L, Mattila K. et al. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 2008; 36: 1110-1115
• 7 Clanton TO, Coupe KJ. Hamstring strains in athletes: Diagnosis and treatment. J Am Acad Orthop Surg 1998; 6: 237-248
• 8 Bierry G, Simeone FJ, Borg-Stein JP. et al. Sacrotuberous ligament: relationship to normal, torn, and retracted hamstring tendons on MR images. Radiology 2014; 271: 162-171
• 9 Williams PL, Bannister LH, Berry MM. Gray’s Anatomy. The Anatomical Basis of Medicine and Surgery. 38th Ed. Edinburgh, Scotland: Churchill Livingstone; 1995: 677-879
• 10 Sato K, Nimura A, Yamaguchi K. et al. Anatomical study of the proximal origin of hamstring muscles. J Orthop Sci 2012; 17: 614-618
• 11 Askling CM, Koulouris G, Saartok T. et al. Total proximal hamstring ruptures: clinical and MRI aspects including guidelines for postoperative rehabilitation. Knee Surg Sports Traumatol Arthrosc 2013; 21: 515-533
• 12 Koulouris G, Connell D. Hamstring muscle complex: An imaging review. RadioGraphics 2005; 25: 571-586
• 13 Wangensteen A, Tol JL, Roemer FW. et al. Intra- and interrater reliability of three different MRI grading and classification systems after acute hamstring injuries. Eur J Radiol 2017; 89: 182-190
• 14 Hamilton B, Whiteley R, Almusa E. et al. Excellent reliability for MRI grading and prognostic parameters in acute hamstring injuries. Br J Sports Med 2014; 48: 1385-1387
• 15 Patel A, Chakraverty J, Pollock N. et al. British athletics muscle injury classification: A reliability study for a new grading system. Clin Radiol 2015; 70: 1414-1420
• 16 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
• 17 Stec N, Arje D, Moody AR. et al. A systematic review of fatigue in radiology: is it a problem?. AJR Am J Roentgenol 2018; 210: 799-806
• 18 Karanicolas PJ, Bhandari M, Kreder H. et al. Evaluating agreement: conducting a reliability study. J Bone Joint Surg Am 2009; 91: 99-106
• 19 Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol 1990; 43: 543-549
• 20 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159
• 21 Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 2005; 19: 231-240
• 22 Franz VH, Loftus GR. Standard errors and confidence intervals in within-subjects designs: generalizing Loftus and Masson (1994) and avoiding the biases of alternative accounts. Psychon Bull Rev 2012; 19: 395-404
• 23 Klingele KE, Sallay PI. Surgical repair of complete proximal hamstring tendon rupture. Am J Sports Med 2002; 30: 742-747