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Assessment of Physical Exam and MRI Findings of Hamstring Injury as Predictors for Recurrent Injury

. . Brief Overview. Exploratory study to identify predictive features of hamstring re-injuryAFL athletes followed for presence or absence of recurrent hamstring injury over same and subsequent seasonData collected: anthropometric, swelling, bruising, tenderness, pain with isometric, pain rating a

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Assessment of Physical Exam and MRI Findings of Hamstring Injury as Predictors for Recurrent Injury

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    1. Assessment of Physical Exam and MRI Findings of Hamstring Injury as Predictors for Recurrent Injury Critique by Rachel Worman and Ellie Stephens

    2. Brief Overview Exploratory study to identify predictive features of hamstring re-injury AFL athletes followed for presence or absence of recurrent hamstring injury over same and subsequent season Data collected: anthropometric, swelling, bruising, tenderness, pain with isometric, pain rating at injury onset, convalescent interval, and size and volume of injury as detected on MRI.

    3. Overview cont. No features associated with increased risk for recurrence within same season Larger size of injury on MRI associated with increased risk when same and subsequent seasons included.

    4. Introduction Problem importance clearly stated Theoretical context supported Appropriate/comprehensive references Study design stated in abstract Purpose/aim clearly stated Lacks hypotheses or guiding questions

    5. Methods: Subjects Population described (highly specific) Inclusion criteria Exclusion criteria Past injury/medical history not mentioned Small sample size

    6. Methods: Design Design identified in abstract only Appropriate for aim of study Not experimental design No randomization No control group 12 Independent variables 1 Dependent variable Subject data measured once Lacks information after injury recurrence

    7. Methods: Instrumentation MRI procedure reliable and valid VAS validity/reliability not referenced Clinical indicators validity/reliability not referenced

    8. Methods: Procedures Detailed description of data collection Treatment protocol in Appendix (not found) Threats to internal validity Hx of previous injury Time of injury within season Mechanism of injury/re-injury Treatment variation between MDs

    9. Methods: Data Analysis Student t tests appropriate (2 groups) Fischer Exact appropriate for small sample size Poisson regression analysis? Alpha level 0.05

    10. Results 30 had MRI studies considered to represent hamstring muscle injury with detection of focal intramuscular T2 hyperintensity 12/30 (40%) had recurrent injury within the same playing season 7/30 had recurrent injury in the subsequent season

    12. Between groups (injured same season vs. non-injured) p= 0.68 Between groups (injured season 2 vs. non-injured) P= 0.22

    13. No variable able to predict re-injury in season 1 (p>.05) Volume and size of initial injury were related to recurrent injury Injury volume more accurate as criterion than injury transverse percent Athletes with MRI-measured injury > 55% were 2.2 times more likely to be reinjured

    14. Calculated volume of injury greater than 21.8 cm3 was 2.3 times more likely when compated to smaller MRI size Short convalescent interval was not associated with recurrent injury (p>.05) When combining seasons p<.01

    15. Study weaknesses Limited # of injury athletes Could relate to type II error relating to inadequate sample size/power Did not take into account the timing in injury with respect to stage in season MRI may not be sensitive enough to pick up subtle HS injury in those with posterior thigh injury

    16. Clinical Relevance No risk factor was detected that increased the risk for recurrent injury within the same playing season Over 2 seasons MRI is useful as a larger risk factor for recurrent injury.

    17. Relevance to skeletal muscle biology Increased volume of injury causes increased # of satellite cells to be activated More centrally located myonuclei would be found in injured region Other factors involved: strength of antagonist muscles, flexibility of hamstring, rate of relaxation ? # of sarcomeres in series determine rate of relaxation?

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