Differing MRI appearances of symptomatic proximal hamstring tendinopathy with ageing: a comparison of appearances in patients below and above 45 years

Abstract

Aim: To compare magnetic resonance imaging (MRI) appearances of symptomatic proximal hamstring tendinopathy (PHT) in younger (<45 years) and older (>45 years) patients.

Materials and methods: MRI of patients with symptomatic PHT were reviewed and compared to asymptomatic age- and sex-matched controls. Appearances recorded were as: type 0, normal tendon; type I, intra-substance signal abnormality; type II, ischial bone and soft-tissue oedema with/without type I findings; type III, curvilinear fluid signal tearing with/without type II findings; type IV, bony avulsion. Disease pattern was compared between age groups using Fisher's exact test.

Results: Thirty-one symptomatic patients (18 male, 13 female; mean age 42 years) were identified. Imaging findings of 16 patients >45 years, 15 patients <45 were as follows: type 0 n=8, type I n=7, type II n=6, type III n=10, type IV n=0. Those >45 years tended to have type III tendinopathy, no examples of type III disease were found in patients <45 years (p<0.001). No significant difference in disease pattern was seen between males and females (p=0.39). Seven of 31 controls >45 years had type III findings and four controls <45 years had type I findings.

Conclusion: MRI appearances of symptomatic PHT differ with age. Differences may reflect mechanism, whereby overuse-related micro-tearing of healthy tendons occurs in young patients versus degenerative tendinopathy in older patients. Abnormal tendon appearances in patients >45 years may or may not be symptomatic. In contrast, abnormalities identified in younger patients are generally symptomatic. These described differences are important in the primary diagnosis and may impact upon patient response to therapy.