Magnetic Resonance Imaging With a Novel Hip Flexion Scanning Position for Diagnosing Proximal Hamstring Tendinopathy

TL;DR

A new MRI scanning position improves the diagnosis of proximal hamstring tendinopathy by revealing more severe injuries than standard scans.

Contribution

A novel hip flexion MRI position is introduced to enhance diagnostic accuracy for proximal hamstring tendinopathy.

Findings

71% of patients showed more severe injury in the hip flexion position compared to the standard position.

16% of tendons showed rupture in the hip flexion position, classified as tendinosis in the standard position.

6% of tendons previously classified as normal in the standard position showed rupture in the hip flexion position.

Abstract

Making a diagnosis of proximal hamstring tendinopathy (PHT) may be challenging, as patients with correlating clinical symptoms may have normal or minimal findings on magnetic resonance imaging (MRI) scans.

The purpose of this study was to assess the effect of a novel hip flexion (HF) scanning position on the MRI diagnosis of PHT. It was hypothesized that the HF position, which simulates the symptom-provoking sitting position, would reveal PHT pathology more accurately than the standard scanning position.

Cohort study (diagnosis); Level of evidence, 3.

Patients with chronic PHT symptoms were included. Chronicity was defined as symptoms that were present for >3 months. Each patient underwent an MRI in 2 parts: (1) the standard pelvic examination in the supine position and (2) the novel HF position in which the patient lays on his or her side with the hip at 90° of flexion. Tendon insertion areas of the semimembranosus and the biceps femoris were analyzed independently by 2 experienced musculoskeletal radiologists, and the findings were classified as normal, tendinosis, or rupture. The MRI findings for both the standard and HF positions were compared in every patient, and the percentage of different diagnoses between the 2 MRI positions was reported.

In total, 38 patients (67 tendons) were analyzed. In 71% of the patients, the HF position revealed more severe injury than the standard position. The HF position showed a rupture in 16% of the tendons, with findings classified as tendinosis in the standard position. Of the tendons diagnosed as normal in the standard position, 6% were classified as rupture and 11% as tendinosis in the HF position.

The novel HF scanning position offered additional value in the diagnosis of PHT in symptomatic patients when compared with the standard hip-in-neutral position. This position can improve the diagnostics of PHT, especially if an athlete or an active patient with gluteal area pain has normal or minimal MRI findings in the standard position.

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