High‐grade intramuscular tendon disruption in acute hamstring injury and return to play in Australian Football players

<jats:sec><jats:title>Background</jats:title><jats:p>Recent literature has reported intramuscular tendon (IT) disruption is associated with longer return to play (RTP) following acute hamstring injury.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>Investigate whether an increase in hamstring injury severity involving high‐grade IT disruption and proximal injury location is associated with longer RTP times in elite Australian Rules Football (AFL) players.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Hamstring injury records and RTP times from one professional AFL club were obtained over six seasons. MRI of injuries was retrospectively reviewed by a musculo‐skeletal radiologist blinded to RTP information. A simplified four‐grade classification of acute hamstring injuries was developed based on IT disruption severity and proximodistal injury location. MR0 had no observable MRI tissue damage; MR1 involved muscle‐tendon junction, myofascial and low‐grade IT injuries; MR2 involved distal and/or single muscle high‐grade IT injuries, and MR3 involved high‐grade IT injuries of the proximal biceps femoris (BF) IT with concomitant injury to BF+ semitendinosus muscles.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Forty‐one injuries were available for analysis. Median RTP times were as follows: MR0, 14 days; MR1, 21 days; MR2, 35 days; and MR3, 88 days. For MRI‐positive injuries (MR1, MR2, MR3), there was a significant difference in the distributions of RTP, with increased injury severity associated with increased RTP times (<jats:italic>P</jats:italic> < .001). The distributions of RTP were significantly different between MR1 vs MR2 (<jats:italic>P</jats:italic> = .008), MR1 vs MR3 (<jats:italic>P</jats:italic> = .002), and MR2 vs MR3 (<jats:italic>P</jats:italic> = .012).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>In elite AFL players, acute hamstring injuries with high‐grade IT disruption identified on MRI were associated with increased times to RTP compared to injuries with low‐grade or no IT disruption.</jats:p></jats:sec>