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Coppola L, Canonico R, DE Luca G, Bisciotti GN, Rusconi G, Barillaro A, DI Pietto F. Magnetic resonance imaging predicts the days lost from training and competition: evaluation of 56 indirect muscle injuries in professional football players. J Sports Med Phys Fitness 2024; 64:279-286. [PMID: 38093638 DOI: 10.23736/s0022-4707.23.15079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
BACKGROUND Lower limb muscle injuries have a strong impact in training and official competitions stoppage for professional football players. This study aimed to explore the relationship between oedema-like changes found on magnetic resonance imaging (MRI) in acute indirect thigh injuries muscles and the time required for the athlete to return to individual training - "return to training" (RTT) and for full availability for official competitions - "return to play" (RTP). METHODS Professional football players from 2017/2018 to 2021/2022 seasons top league team with clinical and ultrasound (US) diagnosis of acute hamstrings or quadriceps muscle injury, confirmed on 48/72h subsequent MRI, were included. MRI images were retrospectively re-evaluated. MRI parameters evaluated were cross-sectional area (CSA), cranio-caudal extension (CCE), distance to nearest insertion (DI) and volume (V). Univariate and multivariate analysis was performed to find factors related to RTT, RTP, and episodes of reinjuries. RESULTS Thirty-four first traumatic muscle injuries met the inclusion criteria. The mean time to RTT and RTP was 22 (4-49) and 25 (4-55) days, respectively. CCE and V resulted as independent predictive MRI variables for the time to RTT (P=0.012) and RTP (P=0.02), respectively. Thresholds of CCE≥11.31 cm and V ≥19.5cc can predict a time to RTT≥22 days (Odds Ratio [OR] 9.5) and RTP≥25 days (OR 4.583), respectively. CONCLUSIONS The decision on the time required for RTP is based on clinic and imaging evaluation; CCE and V of the MRI oedema-like changes help to define the prognosis of the injury.
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Affiliation(s)
- Luigi Coppola
- Department of Radiology, Maddaloni Hospital, Caserta, Italy -
| | - Raffaele Canonico
- Unit of Dietetics, Sport Medicine and Psychophysical Wellbeing, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
- Football Club SSC Napoli, Naples, Italy
| | | | - Gian N Bisciotti
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center Kinemove Rehabilitation Centers, Pontremoli, Parma, La Spezia, Italy
| | - Giovanni Rusconi
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Angela Barillaro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco DI Pietto
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
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2
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Kerin F, O'Flanagan S, Coyle J, Curley D, Farrell G, Persson UM, De Vito G, Delahunt E. Are all hamstring injuries equal? A retrospective analysis of time to return to full training following BAMIC type 'c' and T-junction injuries in professional men's rugby union. Scand J Med Sci Sports 2024; 34:e14586. [PMID: 38375584 DOI: 10.1111/sms.14586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/30/2024] [Accepted: 02/11/2024] [Indexed: 02/21/2024]
Abstract
We aimed to determine whether the anatomical location (intramuscular tendon or T-Junction) of hamstring muscle injuries in professional men's rugby union associates with a prolonged time to return to full training and a higher rate of re-injury/subsequent injury. We reviewed the medical records of an Irish professional rugby union club to identify hamstring muscle injuries incurred across five seasons. Clinicians and players were not blinded to MRI results at the time of rehabilitation. A blinded musculoskeletal radiologist re-classified all included injuries (n = 91) according to the British Athletics Muscle Injury Classification framework. Players who sustained an injury with intramuscular tendon involvement required a longer time to return to full training compared to players who sustained an injury without intramuscular tendon involvement (78 days vs. 24 days). Players who sustained a biceps femoris injury with T-junction involvement did not require a longer time to return to full training compared to players who sustained a biceps femoris injury without T-junction involvement (29 days vs. 27 days). Injuries with either intramuscular tendon or T-junction involvement were not associated with an increased rate of re-injury/subsequent injury to the same limb (intramuscular tendon involvement - odds ratio = 0.96, T-junction involvement - odds ratio = 1.03). When a hamstring muscle injury involves the intramuscular tendon, the injured player and stakeholders should be made aware that a longer time to return to full training is likely required. T-junction involvement does not alter the expected clinical course of biceps femoris injuries.
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Affiliation(s)
- Fearghal Kerin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Stuart O'Flanagan
- Leinster Rugby, Dublin, Ireland
- Sports Medicine Department, UPMC Sports Surgery Clinic, Dublin, Ireland
| | - Joe Coyle
- Sports Medicine Department, UPMC Sports Surgery Clinic, Dublin, Ireland
| | | | | | - Ulrik McCarthy Persson
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | | | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Institute for Sport and Health, University College Dublin, Dublin, Ireland
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3
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Heiss R, Tol JL, Pogarell T, Roemer FW, Reurink G, Renoux J, Crema MD, Guermazi A. Imaging of muscle injuries in soccer. Skeletal Radiol 2023:10.1007/s00256-023-04514-1. [PMID: 37991553 DOI: 10.1007/s00256-023-04514-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/24/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
Accurate diagnosis of muscle injuries is a challenge in everyday clinical practice and may have profound impact on the recovery and return-to-play decisions of professional athletes particularly in soccer. Imaging techniques such as ultrasound and magnetic resonance imaging (MRI), in addition to the medical history and clinical examination, make a significant contribution to the timely structural assessment of muscle injuries. The severity of a muscle injury determined by imaging findings has a decisive influence on therapy planning and affects prognosis. Imaging is of high importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be needed. This narrative review will discuss ultrasound and MRI for the assessment of sports-related muscle injuries in the context of soccer, including advanced imaging techniques, with the focus on the clinical relevance of imaging findings for the prediction of return to play.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Tobias Pogarell
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank W Roemer
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
| | - Guus Reurink
- Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jerome Renoux
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
| | - Michel D Crema
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
| | - Ali Guermazi
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA.
- VA Boston Healthcare System, West Roxbury, MA, USA.
- Department of Radiology, VA Boston Healthcare System, 1400 VFW Parkway, Suite 1B106, West Roxbury, MA, 02132, USA.
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4
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Beattie CE, Barnett RJ, Williams J, Sim J, Pullinger SA. Are return-to-play times longer in lower-limb muscle injuries involving the intramuscular tendon? A systematic review. J Sci Med Sport 2023; 26:599-609. [PMID: 37884432 DOI: 10.1016/j.jsams.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES To determine the influence of severity and direction (craniocaudal length vs cross-sectional area) of intramuscular tendon tears in the lower limb on return-to-play times, compared to muscle injuries without intramuscular tendon involvement. DESIGN Systematic review with meta-analysis. METHODS AMED, CINAHL, SPORTDiscus, ScienceDirect, PubMed (MEDLINE) and Web-of-Science were searched from inception to 31st July 2023, retrieving 666 records, of which nine were deemed eligible. A random-effects meta-analysis was performed on time to return-to-play for British Athletics Muscle Injury Classification 'b' vs 'c'. RESULTS On the Quality in Prognosis Studies tool, one study had low risk of bias and eight had high risk. Using a best-evidence synthesis, no strong evidence emerged for a difference in time to return-to-play between injuries with or without intramuscular tendon involvement. Moderate evidence was found for an association between increased return-to-play time and the presence of "waviness" on magnetic resonance imaging and loss of tendon tension, but no association with longitudinal extent of tendon involvement. Pooled analysis revealed a medium effect-size difference between British Athletics Muscle Injury Classification 'b' and 'c' injuries, favouring classification 'b' (Hedges g = 0.67; 95% confidence interval 0.20 to 1.15; P = 0.002). CONCLUSIONS It remains difficult to provide an accurate prognosis for muscle injuries involving the intramuscular tendon due to high risk of bias and moderate heterogeneity across studies. Moderate evidence favoured the prognosis for injuries at the musculotendinous junction (British Athletics Muscle Injury Classification 'b') over intratendinous injuries (British Athletics Muscle Injury Classification 'c').
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Affiliation(s)
- Catherine E Beattie
- School of Allied Health Professions, Keele University, UK; Sport Science & Medical Department, Wrexham Association Football Club, UK.
| | | | | | - Julius Sim
- School of Allied Health Professions, Keele University, UK.
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5
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Aujla RS, Cecchi S, Koh E, D'Alessandro P, Annear P. Surgical treatment of high-grade acute intramuscular hamstring tendon injuries in athletes leads to predictable return to sports and no re-injuries. Knee Surg Sports Traumatol Arthrosc 2023; 31:4601-4606. [PMID: 37428237 DOI: 10.1007/s00167-023-07477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 06/02/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE The purpose of this study was to assess the post-operative return to sport and re-injury rates following surgical repair of acute, first-time, high-grade intramuscular hamstring tendon injuries in high level athletes. METHODS Patients were identified using the databases of two sports surgeons. Once patients were identified their clinical notes and imaging were reviewed to confirm that all patients had injuries to the intramuscular portion of the distal aspect of the proximal biceps femoris tendon. All imaging was reviewed by an experienced musculoskeletal radiologist to confirm diagnosis. Surgery for such injuries was indicated in high-level athletes presenting with acute hamstring injuries. All patients were operated on within 4 weeks. Outcomes included Tegner scores, return to sport, Lower Extremity Functional Score (LEFS), current hamstring symptoms and complications including re-injury. RESULTS Eleven injuries (10 patients) were included in the study. All patients were male and Australian Rules Football players. Six patients were professional athletes and 4 semi-professional athletes. Median age was 24.5 (range 21-29) and median follow-up period was 33.7 months (range; 16-65). 91% were British Athletic Muscle Injury Classification (BAMIC) 3c and 9% were BAMIC 4c. 91% were classed as MR2 and 9% as MR3 on the simplified four-grade injury classification. Athletes achieved return to play (RTP) at an average of 3.1 months (SD 1.0) post repair. All but one patient achieved a Tegner score equal to pre-injury levels. Maximum LEFS was achieved by all patients. Minor pain scores (all with VAS < 1/10) on sciatic and functional stretch were recorded in 36% and 27% of patients respectively, with subtle neural symptoms (9%) and subjective tightness (36%) also noted. There were no surgical complications in our patient cohort. No patients had a re-injury or re-operation. CONCLUSIONS Surgical repair of high-grade intramuscular tendon injuries of the biceps femoris hamstring muscle in athletes resulted in high levels of return to pre-injury sporting levels and no re-injuries. The intra-muscular tendon should be scrutinized when assessing hamstring injuries in elite sport and offer surgery in high-grade cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Steven Cecchi
- South Metropolitan Health Service, Perth, WA, Australia
| | - Eamon Koh
- South Metropolitan Health Service, Perth, WA, Australia
| | - Peter D'Alessandro
- South Metropolitan Health Service, Perth, WA, Australia
- Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia
- Division of Surgery, Medical School, University of Western Australia, Perth, WA, Australia
| | - Peter Annear
- Perth Orthopaedic and Sports Medicine Centre, Perth, WA, Australia
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6
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Kerin F, O'Flanagan S, Coyle J, Farrell G, Curley D, McCarthy Persson U, De Vito G, Delahunt E. Intramuscular Tendon Injuries of the Hamstring Muscles: A More Severe Variant? A Narrative Review. SPORTS MEDICINE - OPEN 2023; 9:75. [PMID: 37578668 PMCID: PMC10425319 DOI: 10.1186/s40798-023-00621-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 07/20/2023] [Indexed: 08/15/2023]
Abstract
Hamstring strain injuries (HSI) are one of the most common sport-related injuries. They have a high injury burden and a high recurrence rate. The development of novel muscle injury grading systems has provided new insights into the possible impact of injury location on the time to return to play (TTRTP) and re-injury following HSI. In particular, injuries to the intramuscular tendon (IMT) may be present in up to 41% of all HSI and have been described as a 'serious thigh muscle strain'. Re-injury rates as high as 60% have been described in elite track and field athletes, as well as prolonged TTRTP. A systematic search was carried out using appropriate keywords to identify articles reporting on HSI involving the IMT in athletes. The primary aim was to determine whether IMT injuries warrant being classified as a distinct clinical entity with different expected outcomes to other hamstring muscle injuries. This narrative review summarises the existing evidence on: (1) the anatomy of the IMT and its response to injury; (2) the role of MRI and novel grading scales in IMT injury management (3) clinical assessment of IMT injuries, (4) TTRTP and re-injury rates across sports following IMT, (5) conservative rehabilitation and the role of specific 'IMT-oriented' strategies, and (6) indications for and approaches to surgery. The review found that important clinical outcomes such as re-injury rates and TTRTP vary across populations, cohorts and sports which suggest that outcomes are specific to the sporting context. Bespoke rehabilitation, tailored to IMT injury, has been shown to significantly reduce re-injuries in elite track and field athletes, without compromising TTRTP. Continued prospective studies across other sports and cohorts, are warranted to further establish relevant clinical findings, indications for surgical intervention and outcomes across other sporting cohorts.
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Affiliation(s)
- Fearghal Kerin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - Stuart O'Flanagan
- Leinster Rugby, Dublin, Ireland
- Radiology Department, Sports Surgery Clinic, Dublin, Ireland
| | - Joe Coyle
- Radiology Department, Sports Surgery Clinic, Dublin, Ireland
| | | | | | - Ulrik McCarthy Persson
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | | | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Institute for Sport and Health, University College Dublin, Dublin, Ireland
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7
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Paton BM, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Pollock N, Read P, Stirling B, Tulloch L, van Dyk N, Wilson MG, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 1: classification. Br J Sports Med 2023; 57:254-265. [PMID: 36650035 DOI: 10.1136/bjsports-2021-105371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Muscle injury classification systems for hamstring injuries have evolved to use anatomy and imaging information to aid management and prognosis. However, classification systems lack reliability and validity data and are not specific to individual hamstring muscles, potentially missing parameters vital for sport-specific and activity-specific decision making. A narrative evidence review was conducted followed by a modified Delphi study to build an international consensus on best-practice decision-making for the classification of hamstring injuries. This comprised a digital information gathering survey to a cohort of 46 international hamstring experts (sports medicine physicians, physiotherapists, surgeons, trainers and sports scientists) who were also invited to a face-to-face consensus group meeting in London . Fifteen of these expert clinicians attended to synthesise and refine statements around the management of hamstring injury. A second digital survey was sent to a wider group of 112 international experts. Acceptance was set at 70% agreement. Rounds 1 and 2 survey response rates were 35/46 (76%) and 99/112 (88.4%) of experts responding. Most commonly, experts used the British Athletics Muscle Injury Classification (BAMIC) (58%), Munich (12%) and Barcelona (6%) classification systems for hamstring injury. Issues identified to advance imaging classifications systems include: detailing individual hamstring muscles, establishing optimal use of imaging in diagnosis and classification, and testing the validity and reliability of classification systems. The most used hamstring injury classification system is the BAMIC. This consensus panel recommends hamstring injury classification systems evolve to integrate imaging and clinical parameters around: individual muscles, injury mechanism, sporting demand, functional criteria and patient-reported outcome measures. More research is needed on surgical referral and effectiveness criteria, and validity and reliability of classification systems to guide management.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health, University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ricci Plastow
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health, University College London, London, UK.,British Athletics, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Goucester, Gloucester, UK
| | | | | | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK.,Princess Grace Hospital, London, UK
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8
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McAleer S, Macdonald B, Lee J, Zhu W, Giakoumis M, Maric T, Kelly S, Brown J, Pollock N. Time to return to full training and recurrence of rectus femoris injuries in elite track and field athletes 2010-2019; a 9-year study using the British Athletics Muscle Injury Classification. Scand J Med Sci Sports 2022; 32:1109-1118. [PMID: 35332596 DOI: 10.1111/sms.14160] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/25/2021] [Accepted: 03/21/2022] [Indexed: 12/01/2022]
Abstract
Rectus femoris (RF) injuries are common in sports requiring maximal acceleration and sprinting. The British Athletics Muscle Injury Classification (BAMIC) describes acute muscle injury based on the anatomical site of injury and has been associated with return to play in hamstring and calf muscle injury. The aim of this study was to describe and compare the time to return to full training (TRFT) and injury recurrence for BAMIC-classified RF injuries sustained by elite track and field (T&F) athletes over a 9-year period. All rectus femoris injuries sustained by elite T&F athletes on the British Athletics World Class Program between September 2010 and September 2019 that were investigated with an MRI within 7 days of acute onset anterior thigh pain were included. Injuries were graded from the MRI by a specialist musculoskeletal radiologist using the BAMIC, and TRFT and injury recurrence were determined by evaluation of the Electronic Medical Record. Athlete demographics and World Athletics event discipline were recorded. Specific injury details including mechanism, location of injury, and whether surgical or rehabilitation management was undertaken were recorded. There were 38 RF injuries in 27 athletes (24.7 ± 2.3 years; 10 male, 17 female). Average TRFT for rehabilitation managed cases was 20.4 ± 14.8 days. Grade 1 injuries had significantly shorter TRFT compared with grades 2 (p = 0.04) and 3 (p = 0.01). Intratendinous (c) and surgically managed RF injuries each had significantly longer TRFT compared with other injury classes (p < 0.001). Myofascial (a) injuries had reduced repeat injury rates compared with b or c classes (p = 0.048). Grade 3 injuries had an increased repeat injury rate compared with other grades (p = 0.02). There were 4 complete (4c) proximal free tendon injuries sustained during sprinting and all in female athletes. The average TRFT for RF injuries in elite T&F is similar to that previously identified in elite football and Australian Rules. Similar to previous research in hamstring and calf injury, RF injuries extending into the tendon (BAMIC class c) had delayed TRFT which may reflect the longer duration required for tendon healing and adaptation. Grade 3 injuries had in increased repeat injury rate compared with grades 1 and 2. The BAMIC diagnostic framework may provide useful information for clinicians managing rectus femoris injuries in T&F.
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Affiliation(s)
| | - Ben Macdonald
- Wolverhampton Wanderers Football Club, Wolverhampton, UK
| | | | | | | | - Tanya Maric
- Chelsea and Westminster NHS Trust, London, UK.,King's College London, London, UK
| | | | | | - Noel Pollock
- University College London, London, UK.,The Royal Ballet, London, UK.,Institute of Sport, Exercise and Health, London, UK
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9
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Geldenhuys AG, Burgess T, Roche S, Hendricks S. Return to play protocols for musculoskeletal upper and lower limb injuries in tackle-collision team sports: A systematic review. Eur J Sport Sci 2021; 22:1743-1756. [PMID: 34328056 DOI: 10.1080/17461391.2021.1960623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Athletes in tackle-collision teams are at high risk of musculoskeletal injuries resulting in absence from play due to the high impact nature of the sport. There is a paucity of research to guide the management and assessment methods needed to facilitate the return to play (RTP) process. This review aimed to describe, synthesise and evaluate RTP protocols implemented for musculoskeletal injuries in tackle-collision teams. A systematic search of Scopus, PubMed, Web of Science and Ebsco Host was conducted for RTP management protocols and assessment modalities following upper and lower limb musculoskeletal injuries in tackle-collision team athletes. Prospective and retrospective quantitative controlled trials, cohort, case-control, case-series and cross-sectional observation studies published between January 2000 and March 2020 were considered. The main outcome measures were the proportion of athletes to RTP, associated time-loss and reinjury risk. 5265 articles were screened. 34 studies met the eligibility criteria of which 23 involved management and 11 assessment modalities. Management involved surgical or conservative strategies along with exercise-based rehabilitation. Assessment modalities included radiographic assessment, clinical evaluation and subjective ratings. Promising RTP management included progressive weight-bearing and exercised-based rehabilitation for ankle sprains as well as surgery, the use of a sling and exercise-based rehabilitation for shoulder instability. MRI scans showed promise in predicting time-loss following hamstring and calf strains in tackle-collision athletes. There are currently no clear guidelines for RTP after musculoskeletal injuries in tackle-collision sports. Future research should investigate efficient management strategies evaluated through valid and reliable assessment methods to better guide clinicians.
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Affiliation(s)
- A Grethe Geldenhuys
- Division of Exercise Science & Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Newlands, South Africa
| | - Theresa Burgess
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen Roche
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sharief Hendricks
- Division of Exercise Science & Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Newlands, South Africa.,Carnegie Applied Rugby Research (CARR) centre, Institute for Sport Physical Activity and Leisure, Leeds Beckett University, Leeds, England
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10
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Abe S, Yamamoto M. Factors Involved in Morphogenesis in the Muscle-Tendon-Bone Complex. Int J Mol Sci 2021; 22:6365. [PMID: 34198655 PMCID: PMC8232103 DOI: 10.3390/ijms22126365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/12/2021] [Indexed: 12/13/2022] Open
Abstract
A decline in the body's motor functions has been linked to decreased muscle mass and function in the oral cavity and throat; however, aging of the junctions of the muscles and bones has also been identified as an associated factor. Basic and clinical studies on the muscles, tendons and bones, each considered independently, have been published. In recent years, however, research has focused on muscle attachment as the muscle-tendon-bone complex from various perspectives, and there is a growing body of knowledge on SRY-box9 (Sox9) and Mohawk(Mkx), which has been identified as a common controlling factor and a key element. Myostatin, a factor that inhibits muscle growth, has been identified as a potential key element in the mechanisms of lifetime structural maintenance of the muscle-tendon-bone complex. Findings in recent studies have also uncovered aspects of the mechanisms of motor organ complex morphostasis in the superaged society of today and will lay the groundwork for treatments to prevent motor function decline in older adults.
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Affiliation(s)
- Shinichi Abe
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kanda-misakicho, Chiyoda-ku, Tokyo 101-0061, Japan;
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11
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Pollock N, Kelly S, Lee J, Stone B, Giakoumis M, Polglass G, Brown J, MacDonald B. A 4-year study of hamstring injury outcomes in elite track and field using the British Athletics rehabilitation approach. Br J Sports Med 2021; 56:257-263. [PMID: 33853835 DOI: 10.1136/bjsports-2020-103791] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The British Athletics Muscle Injury Classification (BAMIC) correlates with return to play in muscle injury. The aim of this study was to examine hamstring injury diagnoses and outcomes within elite track and field athletes following implementation of the British Athletics hamstring rehabilitation approach. METHODS All hamstring injuries sustained by elite track and field athletes on the British Athletics World Class Programme between December 2015 and November 2019 that underwent an MRI and had British Athletics medical team prescribed rehabilitation were included. Athlete demographics and specific injury details, including mechanism of injury, self-reported gait phase, MRI characteristics and time to return to full training (TRFT) were contemporaneously recorded. RESULTS 70 hamstring injuries in 46 athletes (24 women and 22 men, 24.6±3.7 years) were included. BAMIC grade and the intratendon c classification correlated with increased TRFT. Mean TRFT was 18.6 days for the entire cohort. Mean TRFT for intratendon classifications was 34±7 days (2c) and 48±17 days (3c). The overall reinjury rate was 2.9% and no reinjuries were sustained in the intratendon classifications. MRI variables of length and cross-sectional (CSA) area of muscle oedema, CSA of tendon injury and loss of tendon tension were associated with TRFT. Longitudinal length of tendon injury, in the intratendon classes, was not associated with TRFT. CONCLUSION The application of BAMIC to inform hamstring rehabilitation in British Athletics results in low reinjury rates and favourable TRFT following hamstring injury. The key MRI variables associated with longer recovery are length and CSA of muscle oedema, CSA of tendon injury and loss of tendon tension.
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Affiliation(s)
- Noel Pollock
- Institute of Sport, Exercise and Health, University College London, London, UK .,National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
| | - Shane Kelly
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK.,Ballet Healthcare, The Royal Ballet, London, UK
| | - Justin Lee
- Radiology Department, Fortius Clinic, London, UK
| | - Ben Stone
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
| | - Michael Giakoumis
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
| | - George Polglass
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
| | - James Brown
- National Performance Institute, British Athletics Science and Medicine Team, Loughborough, UK
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