Indirect Rectus Femoris Injury Mechanisms in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings

Video Analysis of Acute Lower Extremity Injury Mechanisms in Soccer Demonstrates Most Anterior Cruciate Ligament, Achilles, and Muscle Injuries Occur Without Direct Contact: A Systematic Review and Meta-analysis

PURPOSE

To systematically review the literature for studies using video analysis to evaluate acute lower extremity injury mechanisms in soccer players.

METHODS

The study was preregistered on PROSPERO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Three databases were searched for Level I to IV studies that quantified lower extremity injury mechanisms in soccer players using video analysis. Data recorded included study demographics, injury type, mechanisms, contact, phase of play, timing, and sagittal plane kinematics. Study methodological quality was analyzed using the Quality Appraisal for Sports Injury Video Analysis Studies scale. Forest plots of proportions were generated for injuries occurring in the first versus second half, defensive versus offensive phase, and contact versus noncontact injury.

RESULTS

Nineteen articles (mean Quality Appraisal for Sports Injury Video Analysis Studies score 14.3 ± 1.9; all Level IV evidence, 1,652 videos, 17 professional males, 1 professional female, 1 both male/female) were included. Anterior cruciate ligament (ACL) tears (49% [42%-55%]), muscle strains (hamstring: 71% [47%-87%]), and Achilles tears (80%-83%) had a high percentage of noncontact (NC) injury mechanisms. Direct and indirect contact-predominant injuries include medial collateral ligament sprains (14% NC) and foot/ankle sprains (6% [4%-10%] NC). Most ACL injuries (68% [61%-75%]) occurred while defending, and quadriceps strains (81%-89%) occurred while attacking.

CONCLUSIONS

In soccer, video analysis shows that a high proportion of acute ACL, Achilles, and muscle injuries occur through noncontact mechanisms, while medial collateral ligament and foot/ankle injuries usually happen with direct contact. ACL injuries are more likely to be sustained when defending, specifically when pressing/tackling, and muscle injuries result from sprinting, kicking, and lunging. Most noncontact-predominant injuries occurred at a higher percentage in the first half, whereas contact-predominant injuries occurred at a higher percentage in the second half.

LEVEL OF EVIDENCE

Level IV, systematic review and meta-analysis of Level IV studies.

Current Concepts of MR Imaging Anatomy and Pathology of the Rectus Femoris Complex

The proximal origin of the rectus femoris from the anterior superior iliac spine, anterior inferior iliac spine and the supraacetabular sulcus comprises the proximal tendinous complex. A practical MR imaging-guided approach adapted to the anatomy of the proximal tendinous complex and the myoconnective transitions along the rectus femoris is critical in accurately evaluating and following rectus femoris injuries. This review presents various conditions, including avulsions, tendon tears, and myoconnecive lesions along the muscle that can result in loss of function and pain. Furthermore, different pathologies or "abnormal states" that can present with symptoms similar to myoconnective lesions are demonstrated.

Leukocyte-Rich Platelet-Rich Plasma Injection in an Acute-on-Chronic Rectus Femoris Injury of a Professional Soccer Player: A Case Report

This is the case of an 18-year-old male professional soccer player, an attacking midfielder, who presented acute-onset pain in his right thigh during a training match but continued playing and training until the end of the session. Two weeks after the initial symptoms, the athlete's pain increased after kicking the ball and stopping training. He came for consultation a week later with tenderness in his right thigh and impaired gait. A 3 ​cm gap in his right mid-quadriceps muscle and tenderness during resisted knee extension and leg raises with no hip or knee range of motion limitations were observed on physical examination. He was scheduled for magnetic resonance imaging (MRI) after the consultation, revealing an acute-on-chronic type 2A lateral muscle tear of the distal rectus femoris. A 2 ​ml seroma aspiration was performed five weeks after the initial injury with a subsequent intra-lesional 1 ​ml liquid leukocyte-rich platelet-rich plasma (LR-PRP) injection using intermittent ultrasound guidance within 5 ​min after preparation. The LR-PRP preparation was classified as 3 14-1 3-0 0 according to the Universal Coding System (UCS) by Kon et al. Nine physiotherapy sessions, including an initial assessment, were conducted over five weeks. The rehabilitation started with pulley exercises with hip flexion, tension arch, leg extension, and squatting with supporting exercises for core and hip strength, with a gradual increase in loading. As the player's symptoms improved, he started doing eccentric exercises such as the reverse Nordics and leg extension. He also followed a running program, gradually increasing speed to a full sprint without pain or irritation. The return-to-sports clearance consultation was conducted seven weeks after the injury, previously confirming satisfactory healing on an MRI. The patient was cleared after passing the Rehabilitation Department battery tests and physical examination. The patient was asymptomatic and had no complaints despite his right quadriceps gap, returning to competition nine weeks after injury. After a one-year follow-up, the patient remains playing at a competitive level, asymptomatic, with no reported reinjury. Adequate reporting of rehabilitation programs and PRP injection characterization is crucial for future research quality improvement and reproducibility.

A systematic review and network meta-analysis on the effectiveness of exercise-based interventions for reducing the injury incidence in youth team-sport players. Part 2: an analysis by movement patterns

The objectives of this network meta-analysis were: (a) to estimate and compare the pooled effects of some injury prevention programs (IPPs) whose exercise-based components were categorized using a movement pattern-specific taxonomy on reducing overall and some specific body regions (lower extremity, thigh, knee, and ankle) injury incidences in youth team sport athletes and (b) to explore the individual effects of these components on the injury incidence rates (IIRs) previously mentioned. Searches were performed in PubMed, Web of Science, SPORTDiscus, and Cochrane Library. Eligible criteria were: exercise-based interventions comprised of exercises involving athletic motor skill competencies and evaluated against a control group, overall IIRs were reported, and youth (≤19 years old) team sport players. For the current analysis, a taxonomy based on movement patterns was employed for exercise component identification (upper body pushing and pulling; lower body concentric and eccentric; core; mechanics; acceleration; and lower body stability). Pooled effects were calculated by frequentist random effects pairwise and network meta-analyses. Nineteen studies were included. Most of the IPPs exhibit risk reduction when compared to their control groups on overall, lower extremity, and ankle injuries. Interventions comprised of lower body concentric and eccentric, core, mechanics, and lower body stability exercises were the most effective measures for reducing these injuries. None of the IPPs demonstrated to be effective for reducing thigh injuries, and contradictory results were found for knee injuries. Individual analysis at component level revealed that the lower body (bilateral and unilateral, concentric, and eccentric) component was the only one associated with a significant reduction on overall injuries. Indirect evidence suggests that interventions incorporating lower body concentric and eccentric, core, mechanics, and lower body stability exercises might be the most effective for reducing overall, lower extremity, and ankle injuries in youth team sports.

The challenge of thigh tendon reinjuries: an expert opinion

This review critically examines the issue of thigh tendon reinjury in athletes, drawing on recent advancements and diverse perspectives in sports medicine. The findings underscore the paramount importance of an early and accurate diagnosis, which significantly influences treatment efficacy and rehabilitation outcomes. We explore the intricacies of tendon anatomy and the mechanisms underlying injuries, highlighting how these factors interplay with athlete-specific risk profiles to affect reinjury rates. A major finding from the review is the necessity for individualized rehabilitation approaches that integrate both traditional methods and emerging technologies. These technologies show promise in enhancing monitoring and facilitating precise adjustments to rehabilitation protocols, thus improving recovery trajectories. Additionally, the review identifies a common shortfall in current practices - premature to play (RTP) - which often results from inadequate adherence to tailored rehabilitation strategies or underestimation of the injury's severity. Such premature RTP significantly heightens the risk of further injury. Through this synthesis of contemporary research and expert opinion, the review advocates for a multidisciplinary approach in managing thigh tendon injuries, emphasizing the need for ongoing research to refine RTP criteria and optimize rehabilitation techniques. The ultimate goal is to support athletes in achieving safer and more effective recoveries, thereby reducing the likelihood of tendon reinjury.

A comparative video analysis of hamstring injuries mechanism and situational pattern in men's and women's football (soccer)

PURPOSE

To describe the injury mechanism and situational patterns of severe (absence >28 days) hamstring muscle injuries in professional male and female football (soccer) players.

METHODS

The data for males were sourced from Serie A clubs participating in both national and international competitions from 2018 to 2021. For the female cohort, hamstring injuries were identified during matches of the top national/international competitions from 2017 to 2023. Video footage was obtained, and three raters categorised injury mechanisms and situational patterns. Injuries were also examined according to the month, minute and location.

RESULTS

A total of 129 severe hamstring injuries were identified, with 64 occurring in females and 65 in males. Video analysis was possible for 29 (45%) female cases and 61 (94%) male cases. Female injuries had longer lay-off times (97.8 ± 77.1 days) than males (39.6 ± 20.9 days). Females had a higher proportion of indirect contact injuries (34%) than males (13%) and a lower proportion of non-contact injuries (66% vs. 87%). Four situational patterns were identified: running was the most common for both sexes, representing 59% of female injuries and 41% of male injuries. Over-stretching injuries were split across open and CKC scenarios but collectively explained nearly half (48%) of male injuries but only one in five (21%) female injuries. Kicking injuries had a higher proportion in females (17%) than males (10%). Injuries were more common in the second half for females and the first half for males.

CONCLUSION

Females had a higher proportion of indirect contact, running and kicking injuries and a lower proportion of non-contact and stretch-type injuries than males. Understanding injury patterns can inform tailored prevention programs, considering sex-specific differences.

LEVEL OF EVIDENCE

Level IV.

Systematic video analysis of shoulder dislocations in professional male football (soccer): Injury mechanisms, situational and kinematic patterns

Purpose

Shoulder dislocations in professional football are severe injuries with an increasing incidence and considerable layoff times. Unlike other football injuries, the mechanisms leading to shoulder dislocations are not well understood, which limits the development of targeted preventive measures. Thus, the aims of this study were: (1) to analyse injury mechanisms of shoulder dislocations in professional football, (2) to evaluate situational and (3) to assess kinematic patterns by performing a systematic video analysis.

Methods

The study included all shoulder dislocations occurring in official matches within Germany's top two professional male football (soccer) leagues (1. and 2. Bundesliga) from the 2012/2013 to the 2022/2023 seasons. A systematic video analysis was performed using the official Bundesliga video database. Two independent reviewers assessed injury-related, situational and kinematic parameters.

Results

A total of 37 shoulder dislocations in 36 players (mean age 25 years) were analysed. Two primary injury mechanisms were identified: Type 1 mechanisms, caused by direct contact to the upper extremity (n = 14), and Type 2 mechanisms, caused by catching a fall (n = 22). Only one case did not fit these categories. Median layoff times were 94 days for Type 1 and 56 days for Type 2, but this difference was not statistically significant. Statistically significant differences between the two types were found in player action (p < 0.001) and type of contact (p = 0.005), while factors like player's speed, movement direction, football-specific actions, ball possession and pitch location showed no statistically significant differences. On-field treatment methods varied, but there were no statistically significant differences in repositioning attempts or reduction techniques (n.s.). Trunk position, shoulder joint version, shoulder elevation, and rotation, as well as elbow and wrist joint positions at the moment of dislocation, were similar between the two types (n.s.).

Conclusion

Shoulder dislocations in professional football typically occur through direct contact or catching a fall, indicating a potential role for specific preventive measures.

Level of Evidence

Level III.