By Katherine Anderson
A prospective case series presented Wednesday by Sandra Mecho Meca, MD, PhD, sheds new light on how proximal hamstring tendons heal after surgery in elite male soccer players.
The study tracked monthly MRI changes to define normal healing patterns and help distinguish them from complications that could delay return-to-play.
Hamstring injuries are common among elite athletes, particularly soccer players, where sprinting and sudden directional changes place high stress on the tendons. Despite the growing number of surgical repairs, there is little documentation of how healing typically appears on MRI.
“MRI is well suited to monitor tendon integration and edema resolution, helping teams recognize expected, stage-specific patterns and avoid misinterpretations—for example, mistaking granulation tissue or immature fibrosis for re-tear,” said Sandra Mecho Meca, MD, a radiologist at Hospital de Barcelona-SCIAS, Creu Blanca Clinic and collaborator with the FC Barcelona Medical Department. “Our goal was to describe normal healing patterns and help differentiate them from potential complications.”
The study followed 15 male professional soccer players with complete proximal hamstring tendon (PHT) ruptures, who underwent PHT repair using Orava and Lempainen’s technique.
Monthly MRI scans were performed for four months using a standardized protocol, resulting in a total of 42 MRIs analyzed. Two blinded radiologists scored seven imaging features, including scar formation, swelling, tendon shape and signs of nerve involvement.
“The short-interval follow-up allowed us to characterize phase-specific signal and morphologic changes and propose a practical timeline of expected findings,” Dr. Mecho Meca said.“This shared framework supports clearer communication between radiologists, surgeons, and sports physicians and more confident, individualized return-to-play decisions.”
Sandra Mecho Meca, MD, PhD
Over time, edema evolved from interstitial and intermuscular to reparative, while signs such as tendon angulation and a blunt muscle outline persisted throughout follow-up.
“We observed that scar ‘fragmentation’ can persist up to the fourth month without implying poor evolution, and that features such as angulation of the repaired tendon and a blunt outline of the biceps femoris may be part of normal healing,” Dr. Mecho Meca said.
While routine monthly MRI is impractical, the researchers propose using their findings as a month-by-month reference map to interpret postoperative imaging when symptoms arise during rehabilitation. Although the study outlines characteristic healing patterns, Dr. Mecho Meca noted that more research is needed to identify imaging features that reliably predict re-injury.
“This shared framework supports clearer communication between radiologists, surgeons, and sports physicians and more confident, individualized return-to-play decisions,” Dr. Mecho Meca concluded.
Access the presentation, “MRI of Postoperative Proximal Hamstring Tendon Healing: New Insights from a Descriptive Case Series,” (W3-SSMK08-4) on demand at RSNA.org/MeetingCentral.
Given typical healing patterns on MRI, should return-to-play decisions for elite athletes ever rely solely on clinical assessment without imaging?
— RSNA (@RSNA) December 3, 2025
© 2025 RSNA.
The RSNA 2025 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, November 30 — Thursday, December 4.
The RSNA 2025 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Suite 200, Oak Brook, IL 60523.
