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Ryskalin L, Morucci G, Soldani P, Gesi M. Do the fasciae of the soleus have a role in plantar fasciitis? Clin Anat 2024; 37:413-424. [PMID: 37539773 DOI: 10.1002/ca.24102] [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: 04/12/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
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2
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Martínez-Silván D, Wik EH, Arnáiz J, Farooq A, Mónaco M. Association Between Magnetic Resonance Imaging Findings and Time to Return to Sport After Muscle Injuries in High-Level Youth Athletes. Clin J Sport Med 2023; 33:225-232. [PMID: 37042815 DOI: 10.1097/jsm.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/04/2022] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To describe the relationship between magnetic resonance imaging (MRI) findings and time to return to sport (RTS) from muscle injuries in youth athletes. DESIGN Prospective collection of injury surveillance data over 6 seasons (2014-2015 to 2019-2020) and reanalysis of MRIs by a radiologist blinded to RTS time after the data collection period. SETTING National sports academy and sports medicine hospital. PARTICIPANTS Male youth (11-19 years) athletes participating in the football (soccer) or athletics (track and field) programs with a muscle injury. INDEPENDENT VARIABLES Magnetic resonance imaging findings (eg, grade and location) in time-loss muscle injuries. MAIN OUTCOME VARIABLES Injury incidence, distributions, and RTS time. RESULTS In total, 353 time-loss muscle injuries were recorded for 1089 athlete-seasons, of which 85 satisfied our inclusion criteria (MRI within 14 days). Return to sport time was significantly longer for reinjuries compared with index injuries. Associations between MRI findings and RTS time were specific to the muscle group, with significant differences in RTS time observed between categories of structure, location, and grade. The largest number of injuries was to the hamstrings (n = 46), where injuries involving the tendon were more severe than those involving the myotendinous junction and muscle, proximal injuries were more severe than mid-portion and distal, and longer RTS time was observed for higher injury grade ( P < 0.05). CONCLUSIONS Muscle injuries in youth are diverse and cannot be treated as a single injury type. Specific injury durations can be expected depending on injury characteristics such as reinjury, location, structure, and grade.
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Affiliation(s)
- Daniel Martínez-Silván
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Eirik Halvorsen Wik
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Rylaan, Tygerberg, South Africa
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Rylaan, Tygerberg, South Africa; and
| | - Javier Arnáiz
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
- School of Medicine-Qatar, Weill Cornell University, Doha, Qatar
| | - Abdulaziz Farooq
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Mauricio Mónaco
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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3
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Nescolarde L, Talluri A, Yanguas J, Lukaski H. Phase angle in localized bioimpedance measurements to assess and monitor muscle injury. Rev Endocr Metab Disord 2023; 24:415-428. [PMID: 36847994 PMCID: PMC10140135 DOI: 10.1007/s11154-023-09790-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/28/2023]
Abstract
Localized bioimpedance (L-BIA) measurements are an innovative method to non-invasively identify structural derangement of soft tissues, principally muscles, and fluid accumulation in response to traumatic injury. This review provides unique L-BIA data demonstrating significant relative differences between injured and contralateral non-injured regions of interest (ROI) associated with soft tissue injury. One key finding is the specific and sensitive role of reactance (Xc), measured at 50 kHz with a phase-sensitive BI instrument, to identify objective degrees of muscle injury, localized structural damage and fluid accretion, determined using magnetic resonance imaging. The predominant effect of Xc as an indicator of severity of muscle injury is highlighted in phase angle (PhA) measurements. Novel experimental models utilizing cooking-induced cell disruption, saline injection into meat specimens, and measurements of changing amounts of cells in a constant volume provide empirical evidence of the physiological correlates of series Xc as cells in water. Findings of strong associations of capacitance, computed from parallel Xc (XCP), with whole body counting of 40-potassium and resting metabolic rate support the hypothesis that parallel Xc is a biomarker of body cell mass. These observations provide a theoretical and practical basis for a significant role of Xc, and hence PhA, to identify objectively graded muscle injury and to reliably monitor progress of treatment and return of muscle function.
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Affiliation(s)
- Lexa Nescolarde
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, c/ Jordi Girona 1-3, Edifici C4, 08034, Barcelona, Spain.
| | | | - Javier Yanguas
- Futbol Club Barcelona, Ciutat Esportiva Joan Gamper, Av. c/ Onze de Setembre s/n, 08790, Sant Joan Despí, Barcelona, Spain
| | - Henry Lukaski
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, ND, 58202, USA
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4
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MRI classification of calf injuries - a reliability study and correlation with return to play in professional rugby players. Skeletal Radiol 2023; 52:61-66. [PMID: 35907017 DOI: 10.1007/s00256-022-04108-3] [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: 03/22/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the validity and reliability of the calf injury classification system proposed by the Olympic Park group which focuses on connective tissue structure integrity on MRI. MATERIALS AND METHODS A retrospective study analysing calf muscle group injuries in an English Premiership professional rugby union club using the MRI classification proposed by the Olympic Park group. Classification on MRI examinations of 28 calf injuries sustained over a 6-year period was performed by three independent musculoskeletal radiologists to determine the inter-observer variability and correlation of the grade of injury with return-to-full-training (RTFT) time. RESULTS RTFT time ranged from 5 to 110 days (mean = 40.1, SD = 26.4) following calf muscle injury. The Olympic Park classification injury grade demonstrated moderate to strong correlation with RTFT time (Spearman's rank correlation coefficient, 0.661-0.715, p < 0.01). RTFT time was statistically different between different injury grades (one-way ANOVA, p < 0.01). Inter-observer agreement of the overall grade between radiologist pairs was fair to moderate (weighted kappa 0.406-0.583). CONCLUSION The Olympic Park classification system demonstrates moderate to strong correlation with time to RTFT following calf injury. Inter-observer reliability is fair to moderate.
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Green B, McClelland JA, Semciw AI, Schache AG, McCall A, Pizzari T. The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians. SPORTS MEDICINE - OPEN 2022; 8:10. [PMID: 35032233 PMCID: PMC8761182 DOI: 10.1186/s40798-021-00364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
Background Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews. Results Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands. Conclusions Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00364-0.
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Anatomical Variability of the Soleus Muscle: A Key Factor for the Prognosis of Injuries? Sports Med 2022; 52:2565-2568. [PMID: 35779203 DOI: 10.1007/s40279-022-01731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 02/01/2023]
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7
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Sergot L, Leaper O, Rolls A, Williams J, Chakraverty R, Chakraverty J. Navigating the complexity of calf injuries in athletes: a review of MRI findings. Acta Radiol 2022; 63:767-774. [PMID: 34018820 DOI: 10.1177/02841851211016452] [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: 11/15/2022]
Abstract
The calf muscle group is a common area for injury within the professional athlete population. Anatomical and biomechanical differences between the different component muscles vary their individual predispositions to and patterns of injury. However, there is a common unifying factor: injuries involving tendinous components have greater clinical implications with regards to rehabilitation, potential intervention, length of time to return to play, and re-injury rates. As such, accurate understanding of the underlying anatomy and subsequent interpretation of the injury patterns carry significant clinical ramifications. Ultrasound is a useful tool but has limitations, particularly when assessing soleus. As such, magnetic resonance imaging remains the workhorse in calf injury investigation.
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Affiliation(s)
- Leon Sergot
- Department of Radiology, University Hospitals Bristol, Bristol, UK
| | - Oliver Leaper
- Wolverhampton Wanderers Football Club, Wolverhampton, UK
| | | | | | | | - Julian Chakraverty
- Department of Radiology, University Hospitals Bristol, Bristol, UK
- Bristol City Football Club, Bristol, UK
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8
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Siedi AF, Rolon AU, Bernard N, Bernasconi J, Palmas M, Couto DA, Pascual TA. Posterior Leg Pain: Understanding Soleus Muscle Injuries. Radiographics 2022; 42:778-788. [PMID: 35427175 DOI: 10.1148/rg.210133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Soleus muscle injuries are frequently unrecognized, representing a common cause of sports inactivity. This is mainly because little is known about the anatomy of the soleus muscle and the clinical manifestations of injury. Unlike other muscles, the soleus muscle has a complex myoconnective structure with three intramuscular tendons, which makes the interpretation of muscle pathologic conditions challenging. Soleus muscle injuries can be acute or chronic and are usually considered to be a minor discomfort by both the patient and the sports medicine physician, leading to a relatively quick return to sporting activity with a high risk for reinjury. The authors review the soleus muscle anatomy and the importance of being familiar with the most frequent locations of injuries, which are fundamental aspects that every radiologist should understand to avoid underdiagnosis. The role of imaging, the clinical manifestations of injuries, and the differential diagnoses are key aspects to know when evaluating posterior leg pain. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Alvaro F Siedi
- From the Department of Radiology, HIMAN, Marcelo T. de Alvear 1719, 5th Floor, Buenos Aires 1060, Argentina
| | - Alejandro U Rolon
- From the Department of Radiology, HIMAN, Marcelo T. de Alvear 1719, 5th Floor, Buenos Aires 1060, Argentina
| | - Nicolas Bernard
- From the Department of Radiology, HIMAN, Marcelo T. de Alvear 1719, 5th Floor, Buenos Aires 1060, Argentina
| | - Juan Bernasconi
- From the Department of Radiology, HIMAN, Marcelo T. de Alvear 1719, 5th Floor, Buenos Aires 1060, Argentina
| | - Martin Palmas
- From the Department of Radiology, HIMAN, Marcelo T. de Alvear 1719, 5th Floor, Buenos Aires 1060, Argentina
| | - Damián A Couto
- From the Department of Radiology, HIMAN, Marcelo T. de Alvear 1719, 5th Floor, Buenos Aires 1060, Argentina
| | - Tomas A Pascual
- From the Department of Radiology, HIMAN, Marcelo T. de Alvear 1719, 5th Floor, Buenos Aires 1060, Argentina
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9
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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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Abstract
The body composition phenotype of an athlete displays the complex interaction among genotype, physiological and metabolic demands of a sport, diet, and physical training. Observational studies dominate the literature and describe the sport-specific physique characteristics (size, shape, and composition) of adult athletes by gender and levels of competition. Limited data reveal how body composition measurements can benefit an athlete. Thus, the objective is to identify purposeful measurements of body composition, notably fat and lean muscle masses, and determine their impact on the health and performance of athletes. Areas of interest include relationships among total and regional body composition measurements, muscle function, sport-specific performance, risk of injury, return to sport after injury, and identification of activity-induced fluid shifts. Discussion includes the application of specific uses of dual X-ray absorptiometry and bioelectrical impedance including an emphasis on the need to minimize measurement errors and standardize protocols, and highlights opportunities for future research. This focus on functional body composition can benefit the health and optimize the performance of an athlete.
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Affiliation(s)
- Henry Lukaski
- Department of Kinesiology and Public Health Education, Hyslop Sports Center, University of North Dakota, Grand Forks, United States
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11
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Draghi F, Bortolotto C, Ferrozzi G. Soleus strain: an underestimated injury? J Ultrasound 2021; 24:201-203. [PMID: 33400251 DOI: 10.1007/s40477-020-00555-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022] Open
Abstract
The medial gastrocnemius is the most commonly injured muscle in the calf, and while traumatic lesions of the medial gastrocnemius are frequently described in the medical literature and clinical and sonographic diagnoses are easy, those of the soleus are less easily recognisable clinically or by sonography. We present a case of traumatic lesions of the medial gastrocnemius, diagnosed clinically and with ultrasound, while MRI also detected two lesions of the soleus. The case presented and the review of the literature highlight how clinical and ultrasound examinations can lead to misunderstandings about traumatic injury to the soleus.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 2, 27100, Pavia, Italy
- Diagnostic Imaging Department, Centro Medico Clastmed, Codevilla, Italy
| | - Chandra Bortolotto
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 2, 27100, Pavia, Italy.
| | - Guia Ferrozzi
- Diagnostic Imaging Department, Centro Medico Inacqua, Piacenza, Italy
- Diagnostic Imaging Department, Centro Medico Riabilitativo Rocca, Piacenza, Italy
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12
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Green B, Lin M, McClelland JA, Semciw AI, Schache AG, Rotstein AH, Cook J, Pizzari T. Return to Play and Recurrence After Calf Muscle Strain Injuries in Elite Australian Football Players. Am J Sports Med 2020; 48:3306-3315. [PMID: 33030961 DOI: 10.1177/0363546520959327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Calf muscle strain injuries (CMSI) are prevalent in sport, but information about factors associated with time to return to play (RTP) and recurrence is limited. PURPOSE To determine whether clinical and magnetic resonance imaging (MRI) data are associated with RTP and recurrence after CMSI. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data of 149 CMSI reported to the Soft Tissue injury Registry of the Australian Football League were explored to evaluate the impact of clinical data and index injury MRI findings on RTP and recurrence. Clinical data included age, previous injury history, ethnicity, and the mechanism of injury. RESULTS Irrespective of the anatomical location, players with CMSI with severe aponeurotic disruption (AD) took longer to RTP than players with CMSI with no AD: 31.3 ± 12.6 days vs 19.4 ± 10.8 days (mean ± SD; P = .003). A running-related mechanism of injury was associated with a longer RTP period for CMSI overall (adjusted hazard ratio [AHR], 0.59; P = .02). The presence of AD was associated with a longer RTP period for soleus injuries (AHR, 0.6; P = .025). Early recurrence (ie, ≤2 months of the index injury) was associated with older age (AHR, 1.3; P = .001) and a history of ankle injury (AHR, 3.9; P = .032). Older age (AHR, 1.1; P = .013) and a history of CMSI (AHR, 6.7; P = .002) increased the risk of recurrence within 2 seasons. The index injury MRI findings were not associated with risk of recurrence. CONCLUSION A running-related mechanism of injury and the presence of AD on MRI were associated with a longer RTP period. Clinical rather than MRI data best indicate the risk of recurrent CMSI.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Monica Lin
- Victoria House Medical Imaging, Melbourne, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.,Northern Centre for Health Education and Research, Northern Health, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | | | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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13
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Pedret C, Balius R, Blasi M, Dávila F, Aramendi JF, Masci L, Fuente J. Ultrasound classification of medial gastrocnemious injuries. Scand J Med Sci Sports 2020; 30:2456-2465. [DOI: 10.1111/sms.13812] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Carles Pedret
- Sports Medicine Department Clínica Diagonal Barcelona Spain
- Sports Medicine and Imaging Department Clínica Creu Blanca Barcelona Spain
| | - Ramon Balius
- Sports Medicine Department Clínica Diagonal Barcelona Spain
- Consell Català de l’Esport Generalitat de Catalunya Barcelona Spain
| | - Marc Blasi
- Plastic Surgery Department Hospital Germans Trias i Pujol Badalona Spain
| | - Fernando Dávila
- Orthopedic Department Clínica Pakea—Mutualia San Sebastián Spain
| | - José F. Aramendi
- Orthopedic Department Clínica Pakea—Mutualia San Sebastián Spain
| | - Lorenzo Masci
- Institute of Sports Exercise and Health (ISEH) London UK
| | - Javier Fuente
- Orthopedic Department Clínica Pakea—Mutualia San Sebastián Spain
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14
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Nescolarde L, Terricabras J, Mechó S, Rodas G, Yanguas J. Differentiation Between Tendinous, Myotendinous and Myofascial Injuries by L-BIA in Professional Football Players. Front Physiol 2020; 11:574124. [PMID: 33013488 PMCID: PMC7500181 DOI: 10.3389/fphys.2020.574124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/14/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To differentiate by localized bioimpedance (L-BIA) measurements 24 h after injury, between tendinous, myotendinous junction (MTJ), and myofascial junction (MFJ) injuries, previously diagnosed by MRI exam. To evaluate by L-BIA, the severity of MTJ injuries graded from 1 to 3, and to determine the relationship between days to return to play (RTP) and L-BIA measurements. Methods 3T MRI and tetra polar L-BIA was used to analyzed 37 muscle injuries 24 h after injury in 32 male professional football players, (23.5 ± 1.5 kg m–2; 1.8 ± 0.1 m; 20–30 year.) between the 2016–2017 and 2017–2018 seasons. Muscle injuries were classified by The British Athletics Muscle Injury Classification (BAMIC). Percentage difference of L-BIA parameters [resistance (R), reactance (Xc), and phase angle (PA)] of the injured side were calculated considering contralateral non-injured side as the reference value. Results According to BAMIC classification and by MRI exam, we found tendinous (n = 4), MTJ (n = 26), and MFJ (n = 7) muscle injuries. In addition, MTJ injuries were grouped according to the severity of injury in grade 1 (n = 11), grade 2 (n = 8), and grade 3 (n = 7). Significant decrease (P < 0.01) was found in the L-BIA parameters R, Xc, and PA, in both MTJ and MFJ as well as in the different grades of MTJ injuries. In particular, in Xc (P < 0.001), which is related to muscle cell disruption. Regarding days to RTP, there was statistical significance among the three different grades of MTJ injuries (P < 0.001), especially when grade 1 was compared to grade 3 and grade 2 compared to 3. Conclusion L-BIA is a complementary method to imaging diagnostic techniques, such as MRI and US, to quantify MTJ and MFJ injuries. In addition, the increase in the severity of the MTJ injury resulted in higher changes of the Xc parameter and longer time to RTP.
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Affiliation(s)
- Lexa Nescolarde
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Joaquim Terricabras
- Medical Department, Futbol Club Barcelona, FIFA Medical Center of Excelence, Barcelona, Spain.,Department of Surgery, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sandra Mechó
- Medical Department, Futbol Club Barcelona, FIFA Medical Center of Excelence, Barcelona, Spain.,Department of Radiology, SCIAS-Hospital de Barcelona, Barcelona, Spain
| | - Gil Rodas
- Medical Department, Futbol Club Barcelona, FIFA Medical Center of Excelence, Barcelona, Spain
| | - Javier Yanguas
- Medical Department, Futbol Club Barcelona, FIFA Medical Center of Excelence, Barcelona, Spain
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Ultrasound-Guided Percutaneous Needle Electrolysis in Dancers with Chronic Soleus Injury: A Randomized Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4156258. [PMID: 32908559 PMCID: PMC7474345 DOI: 10.1155/2020/4156258] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022]
Abstract
Damage to intramuscular tendons is very common in sports injuries, specifically in soleus muscle injuries. This study sought to compare the effects of applying ultrasound- (US-) guided percutaneous needle electrolysis (PNE) in combination with an eccentric exercise program on pain and functionality in dancers with chronic soleus injury, located in the central tendon. Thirty dancers with injured central tendon of the soleus muscle were randomly allocated to a PNE group (n = 10), an eccentric exercise group (n = 10), or a combined group (n = 10). Pain, ankle dorsiflexion range of motion (DROM), endurance, the heel raise test, the DFOS questionnaire, and the minimal clinically important difference (MCID) were analyzed at baseline and after treatment (four weeks). Over half (52%) of the dancers had a chronic soleus muscle injury. Variables for pain, DROM, the heel rise test, ADL, technique, DFOS total, and DFOS-subjective variables showed significant differences (P < 0.05) in pretreatment and posttreatment in all groups, whereas no significant differences were observed between intervention groups. However, the combined group showed a higher percentage of changes compared to the other groups, and these dancers had greater perceived changes (MCID = 4.70 ± 1.42). The conclusion of the study was that dancers with chronic soleus injury, located in the central tendon, treated with a combination of US-guided PNE and an eccentric exercise program displayed improved outcomes compared to the application of PNE therapy or eccentric exercise alone. The US-guided PNE, combined with an eccentric exercise program, is a useful therapeutic tool for the treatment of chronic soleus injury, located in the central tendon. The trial is registered with NCT04042012.
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16
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A proposal for a new classification of soleus muscle morphology. Ann Anat 2020; 232:151584. [PMID: 32810614 DOI: 10.1016/j.aanat.2020.151584] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The soleus muscle (SM) is located in the superficial posterior compartment of the leg, together with the gastrocnemius muscle (GM) and plantaris muscle. There is little information on the morphological variability (pennation) of the SM. The aim of the study is to characterize the variations in the morphology of the pennation of the SM and to create the first accurate classification. MATERIAL AND METHODS Eighty lower limbs (40 left, and 40 right) fixed in 10% formalin solution were examined. The morphology of the central tendon, medial and lateral aponeuroses was evaluated, together with the pennation angle. RESULTS In all cases, the soleus muscle was present. Four types could be distinguished based on muscle fibre morphology. In order of frequency: Type 1 - bipennate (43.75%); Type 4 - non-pennate (36.25%); Type 2 - unipennate (15%); Type 3 - multipennate (5%). No significant difference in type distribution was observed with regard to body side (p=0.9018) or gender (p=0.0844). CONCLUSION The soleus muscle is characterized by high morphological variability. Based on the pennation angle, four types (1-4) of soleus muscle are distinguishable.
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17
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Ishøi L, Krommes K, Husted RS, Juhl CB, Thorborg K. Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport - grading the evidence: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med 2020; 54:528-537. [PMID: 31937579 PMCID: PMC7212929 DOI: 10.1136/bjsports-2019-101228] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 01/09/2023]
Abstract
This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.
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Affiliation(s)
- Lasse Ishøi
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark
| | - Kasper Krommes
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark
| | - Rasmus Skov Husted
- Department of Orthopedic Surgery and Physical Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Carsten B Juhl
- Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kristian Thorborg
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark
- Department of Orthopedic Surgery and Physical Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
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18
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Balius R, Blasi M, Pedret C, Alomar X, Peña-Amaro J, Vega JA, Pruna R, Ardèvol J, Álvarez G, de la Fuente J, Fernández-Jaén T, Järvinen TA, Rodas G. A Histoarchitectural Approach to Skeletal Muscle Injury: Searching for a Common Nomenclature. Orthop J Sports Med 2020; 8:2325967120909090. [PMID: 32232071 PMCID: PMC7092384 DOI: 10.1177/2325967120909090] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
In recent years, different classifications for muscle injuries have been proposed based on the topographic location of the injury within the bone-tendon-muscle chain. We hereby propose that in addition to the topographic classification of muscle injuries, a histoarchitectonic (description of the damage to connective tissue structures) definition of the injury be included within the nomenclature. Thus, the nomenclature should focus not only on the macroscopic anatomy but also on the histoarchitectonic features of the injury.
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Affiliation(s)
| | - Ramon Balius
- Ramon Balius, MD, PhD, Consell Català de l’Esport, Generalitat de Catalunya, Av. dels Països Catalans, 12, 08950 Esplugues de Llobregat, Barcelona, Spain ()
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19
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Green B, Lin M, Schache AG, McClelland JA, Semciw AI, Rotstein A, Cook J, Pizzari T. Calf muscle strain injuries in elite Australian Football players: A descriptive epidemiological evaluation. Scand J Med Sci Sports 2020; 30:174-184. [PMID: 31494970 DOI: 10.1111/sms.13552] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Calf muscle strain injuries (CMSI) show consistent rates of prevalence and re-injury in elite Australian Football players. An epidemiological evaluation is warranted to better understand the clinical presentation and recovery of CMSI. PURPOSE First, to describe the epidemiology of CMSI in elite Australian Football players. Second, to determine if recovery following injury is different according to: (a) injury type (index vs re-injury); (b) muscle injured (soleus vs gastrocnemius); and (c) mechanism of injury (running-related activity vs non running-related activity). STUDY DESIGN Descriptive epidemiological. METHODS Data retrieved from the Soft Tissue injury Registry of the Australian Football League were analyzed. Sixteen clubs submitted data on CMSI from 2014 to 2017. Data included: player characteristics, training and match history at the time of injury, MRI, and the time to reach recovery milestones. RESULTS One hundred and eighty-four CMSI were included (149 index injuries; 35 re-injuries). Soleus injuries were most prevalent (84.6%). Soleus injuries took 25.4 ± 16.2 days to return to play, whereas gastrocnemius injuries took 19.1 ± 14.1 days (P = .097). CMSI sustained during running-related activities took approximately 12 days longer to recover than injuries sustained during non running-related activities (P = .001). Compared to index injuries, re-injuries involved older players (P = .03) and significantly more time was taken to run at >90% of maximum speed, return to full training, and return to play (P ≤ .001). Almost all of the observed re-injuries involved soleus (91.4%). CONCLUSION Soleus injuries are more prevalent than gastrocnemius injuries in elite Australian Football players. Prognosis appears to be influenced by clinical factors, with CMSI sustained during running-related activities and re-injuries needing more time to recover.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Monica Lin
- Victoria House Imaging, Melbourne, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | | | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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20
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Wilke J, Hespanhol L, Behrens M. Is It All About the Fascia? A Systematic Review and Meta-analysis of the Prevalence of Extramuscular Connective Tissue Lesions in Muscle Strain Injury. Orthop J Sports Med 2019; 7:2325967119888500. [PMID: 31903399 PMCID: PMC6931154 DOI: 10.1177/2325967119888500] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The fascia has been demonstrated to represent a potential force transmitter
intimately connected to the underlying skeletal muscle. Sports-related soft
tissue strains may therefore result in damage to both structures. Purpose: To elucidate the prevalence of connective tissue lesions in muscle strain
injury and their potential impact on return-to-play (RTP) duration. Study Design: Systematic review; Level of evidence, 3. Methods: Imaging studies describing frequency, location, and extent of soft tissue
lesions in lower limb muscle strain injuries were identified by 2
independent investigators. Weighted proportions (random effects) were pooled
for the occurrence of (1) myofascial or fascial lesions, (2) myotendinous
lesions, and (3) purely muscular lesions. Study quality was evaluated by
means of an adapted Downs and Black checklist, which evaluates reporting,
risk of bias, and external validity. Results: A total of 16 studies (fair to good methodological quality) were identified.
Prevalence of strain injury on imaging studies was 32.1% (95% CI,
24.2%-40.4%) for myofascial lesions, 68.4% (95% CI, 59.6%-76.6%) for
myotendinous lesions, and 12.7% (95% CI, 3.0%-27.7%) for isolated muscular
lesions. Evidence regarding associations between fascial damage and RTP
duration was mixed. Conclusion: Lesions of the collagenous connective tissue, namely the fascia and the
tendinous junction, are highly prevalent in athletic muscle strain injuries.
However, at present, their impact on RTP duration is unclear and requires
further investigation.
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Affiliation(s)
- Jan Wilke
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Luiz Hespanhol
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Sao Paulo, Brazil.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, Academic Medical Center/VU University Medical Center IOC Research Center, Amsterdam, the Netherlands
| | - Martin Behrens
- Institute of Sport Science, University of Rostock, Rostock, Germany
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21
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Krutsch W, Eder K, Krutsch V, Meyer T. ["Stay and play" in football : Art of keeping players fit to play]. Unfallchirurg 2019; 121:433-440. [PMID: 29637217 DOI: 10.1007/s00113-018-0487-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many publications about the treatment and return to play after severe football injuries are available from the scientific literature, particularly about injuries requiring surgery. In contrast, less severe football injuries, such as muscle strains, ankle sprains and contusions, are less well addressed in the literature although these represent the most frequent type of injury. Additionally, such reports often have a low level of evidence and guidelines on treatment and the return to play process are very rare. Thus, the time away from football and the timing of return to play after minor injuries depends on the experience and skills of the responsible medical team. To achieve the aim of stay and play on the field, the medical team should be highly knowledgeable in interdisciplinary football medicine, prevention strategies, first aid on the field, clinical and manual diagnostics, tissue regeneration, symptomatic and conservative treatment as well as in return to play decision-making. No consensus exists on stay and play procedures neither on the practical level nor on the scientific level regarding injury definition, the diagnostic and treatment options and stay and play criteria. Therefore, this article presents the first steps for assessing stay and play strategies after minor injuries to standardize and improve practical routine, education and scientific research.
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Affiliation(s)
- Werner Krutsch
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | | | - Volker Krutsch
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - Tim Meyer
- Institut für Sport- und Präventivmedizin, Universität des Saarlandes, Saarbrücken, Deutschland
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22
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Macdonald B, McAleer S, Kelly S, Chakraverty R, Johnston M, Pollock N. Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice. Br J Sports Med 2019; 53:1464-1473. [DOI: 10.1136/bjsports-2017-098971] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Abstract
RationaleHamstring injuries are common in elite sports. Muscle injury classification systems aim to provide a framework for diagnosis. The British Athletics Muscle Injury Classification (BAMIC) describes an MRI classification system with clearly defined, anatomically focused classes based on the site of injury: (a) myofascial, (b) muscle–tendon junction or (c) intratendinous; and the extent of the injury, graded from 0 to 4. However, there are no clinical guidelines that link the specific diagnosis (as above) with a focused rehabilitation plan.ObjectiveWe present an overview of the general principles of, and rationale for, exercise-based hamstring injury rehabilitation in British Athletics. We describe how British Athletics clinicians use the BAMIC to help manage elite track and field athletes with hamstring injury. Within each class of injury, we discuss four topics: clinical presentation, healing physiology, how we prescribe and progress rehabilitation and how we make the shared decision to return to full training. We recommend a structured and targeted diagnostic and rehabilitation approach to improve outcomes after hamstring injury.
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23
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Pezzotta G, Pecorelli A, Querques G, Biancardi S, Morzenti C, Sironi S. MRI characteristics of adductor longus lesions in professional football players and prognostic factors for return to play. Eur J Radiol 2018; 108:52-58. [DOI: 10.1016/j.ejrad.2018.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
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24
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Valle X, Alentorn-Geli E, Tol JL, Hamilton B, Garrett WE, Pruna R, Til L, Gutierrez JA, Alomar X, Balius R, Malliaropoulos N, Monllau JC, Whiteley R, Witvrouw E, Samuelsson K, Rodas G. Muscle Injuries in Sports: A New Evidence-Informed and Expert Consensus-Based Classification with Clinical Application. Sports Med 2018; 47:1241-1253. [PMID: 27878524 DOI: 10.1007/s40279-016-0647-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Muscle injuries are among the most common injuries in sport and continue to be a major concern because of training and competition time loss, challenging decision making regarding treatment and return to sport, and a relatively high recurrence rate. An adequate classification of muscle injury is essential for a full understanding of the injury and to optimize its management and return-to-play process. The ongoing failure to establish a classification system with broad acceptance has resulted from factors such as limited clinical applicability, and the inclusion of subjective findings and ambiguous terminology. The purpose of this article was to describe a classification system for muscle injuries with easy clinical application, adequate grouping of injuries with similar functional impairment, and potential prognostic value. This evidence-informed and expert consensus-based classification system for muscle injuries is based on a four-letter initialism system: MLG-R, respectively referring to the mechanism of injury (M), location of injury (L), grading of severity (G), and number of muscle re-injuries (R). The goal of the classification is to enhance communication between healthcare and sports-related professionals and facilitate rehabilitation and return-to-play decision making.
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Affiliation(s)
- Xavier Valle
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain. .,Sports Medicine School, Universitat de Barcelona, Barcelona, Spain. .,Mapfre Centre for Tennis Medicine, Barcelona, Spain. .,Department de Cirurgia de la Facultat de Medicina, 'Universitat Autònoma de Barcelona', Barcelona, Spain.
| | - Eduard Alentorn-Geli
- Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA
| | - Johannes L Tol
- Department of Sports Medicine, Aspetar, Doha, Qatar.,Department of Sports Medicine, The Sports Physician Group, OLVG-West, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Bruce Hamilton
- Department of Sports Medicine, Aspetar, Doha, Qatar.,High Performance Sport NZ, Millenium Institute of Sport and Health, Auckland, New Zealand
| | - William E Garrett
- Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA
| | - Ricard Pruna
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain
| | - Lluís Til
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain.,High Performance Centre, Health Consortium of Terrassa, Barcelona, Spain
| | - Josep Antoni Gutierrez
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain.,Sport Catalan Council, Generalitat de Catalunya, Barcelona, Spain
| | | | - Ramón Balius
- Mapfre Centre for Tennis Medicine, Barcelona, Spain.,Sport Catalan Council, Generalitat de Catalunya, Barcelona, Spain
| | - Nikos Malliaropoulos
- Musculoskeletal Department, Thessaloniki Sports Medicine Clinic, Thessaloníki, Greece.,Department of Rheumatology, Sports Clinic, Mile End Hospital, Barts Health NHS Trust, London, UK
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar-Hospital del Mar and Hospital de l'Esperança, Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital Universitari Dexeus (ICATME), Barcelona, Spain
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Erik Witvrouw
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Kristian Samuelsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Göteburg, Sweden
| | - Gil Rodas
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain
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25
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Considerations in the Diagnosis and Accelerated Return to Sport of a Professional Basketball Player With a Triceps Surae Injury: A Case Report. J Orthop Sports Phys Ther 2018; 48:388-397. [PMID: 29623750 DOI: 10.2519/jospt.2018.7192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Case report. Background Acute injuries of the triceps surae and Achilles tendon are common in sports. Rupture of the plantaris tendon can be challenging to diagnose. There is limited evidence detailing the diagnosis, rehabilitation, and accelerated return to sport of elite professional basketball players who have sustained calf injuries. Case Description A 25-year-old male professional basketball player sustained an injury to his calf during a professional basketball game. This case report details the presumptive diagnosis, graduated progression of intervention, and return to play of a professional athlete with a likely isolated plantaris tendon tear. Outcomes The patient returned to postseason competition 10 days post injury. Objective measures were tracked throughout rehabilitation and compared to baseline assessments. Before returning to play, the athlete showed improvements beyond the minimal clinically important difference for calf girth (2 cm) and numeric pain-rating scale score (4 points, 0-10 scale). Functional testing was conducted that included the Y Balance Test lower quarter and the Functional Movement Screen, with results that exceeded or returned the athlete to preseason levels. Discussion This report details the case of a professional basketball player who returned to competitive play in an accelerated time frame following injury to his calf. Diagnosing a plantaris tendon rupture can be challenging, and anatomical variations of this muscle should be considered. It was demonstrated in this case that physical therapy rehabilitation was helpful in making a treatment-based clinical diagnosis when imaging was unclear. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2018;48(5):388-397. Epub 6 Apr 2018. doi:10.2519/jospt.2018.7192.
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26
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New MRI muscle classification systems and associations with return to sport after acute hamstring injuries: a prospective study. Eur Radiol 2018; 28:3532-3541. [PMID: 29460072 DOI: 10.1007/s00330-017-5125-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 10/01/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine agreement between modified Peetrons, Chan acute muscle strain injury classification and British Athletics Muscle Injury Classification (BAMIC) and to investigate their associations and ability to predict time to return to sport (RTS). METHODS Male athletes (n=176) with acute hamstring injury and MRI (1.5T) ≤5 days were followed until RTS. MRIs were scored using standardised forms. RESULTS For MRI-positive injuries there was moderate agreement in severity grading (κ = 0.50-0.56). Substantial variance in RTS was demonstrated within and between MRI categories. Mean differences showed an overall main effect for severity grading (p < 0.001), but post hoc pairwise comparisons for BAMIC (grade 0a/b vs. 1, p = 0.312; 1 vs 2, p = 0.054; 0a/b vs 2, p < 0.001; 1 vs 3, p < 0.001) and mean differences for anatomical sites (BAMIC a-c, p < 0.001 [a vs b, p = 0.974; a vs c, p = 0.065; b vs c, p = 0.007]; Chan anatomical sites 1-5, p < 0.077; 2A-C, p = 0.373; 2a-e, p = 0.008; combined BAMIC, p < 0.001) varied. For MRI-positive injuries, total explained RTS variance was 7.6-11.9% for severity grading and BAMIC anatomical sites. CONCLUSIONS There was wide overlap between/variation within the grading/classification categories. Therefore, none of the classification systems could be used to predict RTS in our sample of MRI-positive hamstring injuries. KEY POINTS • Days to RTS varied greatly within the grading and classification categories. • Days to RTS varied greatly between the grading and classification categories. • Using MRI classification systems alone to predict RTS cannot be recommended. • The specific MRI classification used should be reported to avoid miscommunication.
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27
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Prakash A, Entwisle T, Schneider M, Brukner P, Connell D. Connective tissue injury in calf muscle tears and return to play: MRI correlation. Br J Sports Med 2017; 52:929-933. [DOI: 10.1136/bjsports-2017-098362] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 01/12/2023]
Abstract
ObjectiveThe aim of our study was to assess a group of patients with calf muscle tears and evaluate the integrity of the connective tissue boundaries and interfaces. Further, we propose a novel MRI grading system based on integrity of the connective tissue and assess any correlation between the grading score and time to return to play. We have also reviewed the anatomy of the calf muscles.Materials and methodsWe retrospectively evaluated 100 consecutive patients with clinical suspicion and MRI confirmation of calf muscle injury. We evaluated each calf muscle tear with MRI for the particular muscle injured, location of injury within the muscle and integrity of the connective tissue structure at the interface. The muscle tears were graded 0–3 depending on the degree of muscle and connective tissue injury. The time to return to play for each patient and each injury was found from the injury records and respective sports doctors.ResultsIn 100 patients, 114 injuries were detected. Connective tissue involvement was observed in 63 out of 100 patients and failure (grade 3 injury) in 18. Mean time to return to play with grade 0 injuries was 8 days, grade 1 tears was 17 days, grade 2 tears was 25 days and grade 3 tears was 48 days (p<0.001).ConclusionThe integrity of the connective tissue can be used to estimate and guide the time to return to play in calf muscle tears.
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28
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Rubin DA. MRI of Sports Injuries in the Leg. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Serner A, Weir A, Tol JL, Thorborg K, Roemer F, Guermazi A, Yamashiro E, Hölmich P. Characteristics of acute groin injuries in the adductor muscles: A detailed MRI study in athletes. Scand J Med Sci Sports 2017. [PMID: 28649700 DOI: 10.1111/sms.12936] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute adductor injuries account for the majority of acute groin injuries; however, little is known about specific injury characteristics, which could be important for the understanding of etiology and management of these injuries. The study aim was to describe acute adductor injuries in athletes using magnetic resonance imaging (MRI). Male athletes with acute groin pain and an MRI confirmed acute adductor muscle injury were prospectively included. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. 156 athletes presented with acute groin pain of which 71 athletes were included, median age 27 years (range 18-37). There were 46 isolated muscle injuries and 25 athletes with multiple adductor injuries. In total, 111 acute adductor muscle injuries were recorded; 62 adductor longus, 18 adductor brevis, 17 pectineus, 9 obturator externus, 4 gracilis, and 1 adductor magnus injury. Adductor longus injuries occurred at three main injury locations; proximal insertion (26%), intramuscular musculo-tendinous junction (MTJ) of the proximal tendon (26%) and the MTJ of the distal tendon (37%). Intramuscular tendon injury was seen in one case. At the proximal insertion, 12 of 16 injuries were complete avulsions. This study shows that acute adductor injuries generally occur in isolation from other muscle groups. Adductor longus is the most frequently injured muscle in isolation and in combination with other adductor muscle injuries. Three characteristic adductor longus injury locations were observed on MRI, with avulsion injuries accounting for three-quarters of injuries at the proximal insertion, and intramuscular tendon injury was uncommon.
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Affiliation(s)
- A Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopaedic Research Center (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - A Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - J L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Sports Medicine, OLVG, The Sports Physician Group, Amsterdam, The Netherlands.,Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - K Thorborg
- Sports Orthopaedic Research Center (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - F Roemer
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - A Guermazi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - E Yamashiro
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - P Hölmich
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopaedic Research Center (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
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30
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Nescolarde L, Yanguas J, Terricabras J, Lukaski H, Alomar X, Rosell-Ferrer J, Rodas G. Detection of muscle gap by L-BIA in muscle injuries: clinical prognosis. Physiol Meas 2017. [PMID: 28636566 DOI: 10.1088/1361-6579/aa7243] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Sport-related muscle injury classifications are based basically on imaging criteria such as ultrasound (US) and magnetic resonance imaging (MRI) without consensus because of a lack of clinical prognostics for return-to-play (RTP), which is conditioned upon the severity of the injury, and this in turn with the muscle gap (muscular fibers retraction). Recently, Futbol Club Barcelona's medical department proposed a new muscle injury classification in which muscle gap plays an important role, with the drawback that it is not always possible to identify by MRI. Localized bioimpedance measurement (L-BIA) has emerged as a non-invasive technique for supporting US and MRI to quantify the disrupted soft tissue structure in injured muscles. OBJECTIVE To correlate the severity of the injury according to the gap with the RTP, through the percent of change in resistance (R), reactance (Xc) and phase-angle (PA) by L-BIA measurements in 22 muscle injuries. MAIN RESULTS After grouping the data according to the muscle gap (by MRI exam), there were significant differences in R between grade 1 and grade 2f (myotendinous or myofascial muscle injury with feather-like appearance), as well as between grade 2f and grade 2g (myotendinous or myofascial muscle injury with feather and gap). The Xc and PA values decrease significantly between each grade (i.e. 1 versus 2f, 1 versus 2g and 2f versus 2g). In addition, the severity of the muscle gap adversely affected the RTP with significant differences observed between 1 and 2g as well as between 2f and 2g. SIGNIFICANCE These results show that L-BIA could aid MRI and US in identifying the severity of an injured muscle according to muscle gap and therefore to accurately predict the RTP.
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Affiliation(s)
- L Nescolarde
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, c/Jordi Girona, 1-3, Edifici C4, 08034 Barcelona, Spain
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31
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MRI assessment of calf injuries in Australian Football League players: findings that influence return to play. Skeletal Radiol 2017; 46:343-350. [PMID: 28093618 DOI: 10.1007/s00256-016-2564-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/24/2016] [Accepted: 12/27/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Calf muscle strains have become increasingly prevalent in recent seasons of the Australian Football League (AFL) and represent a significant cause of time lost from competition. The purpose of this study was to examine the association between MRI features of calf muscle strains and games missed and to thereby identify parameters that are of prognostic value. MATERIALS AND METHODS A retrospective analysis of MRI scans of AFL players with calf strains referred to a musculoskeletal radiology clinic over a 5-year period (2008-2012) was performed. The muscle(s) and muscle component affected, the site and size of strain, and the presence of an intramuscular tendon tear or intermuscular fluid were recorded. These data were cross-referenced with whether a player missed at least one game. Imaging features of prognostic value were thus identified. RESULTS Sixty-three athletes had MRI scans for calf muscle strains. Soleus strains were more common than strains of other muscles. Players with soleus strains were more likely to miss at least one game if they had multiple muscle involvement (p = 0.017), musculotendinous junction strains (p = 0.046), and deep strains (p = 0.036). In a combined analysis of gastrocnemius and soleus strains, intramuscular tendon tears were observed in a significantly greater proportion of players who missed games (p = 0.010). CONCLUSION Amongst AFL players with calf injuries, there is an association between missing at least one game and multiple muscle involvement, musculotendinous junction strains, deep strain location, and intramuscular tendon tears. In this setting, MRI may therefore provide prognostic information to help guide return-to-play decisions.
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Werner BC, Belkin NS, Kennelly S, Weiss L, Barnes RP, Potter HG, Warren RF, Rodeo SA. Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes. Orthop J Sports Med 2017; 5:2325967116680344. [PMID: 28203595 PMCID: PMC5298443 DOI: 10.1177/2325967116680344] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied. PURPOSE To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of all acute calf muscle injuries on a single NFL team from 2003 to 2015 was performed. Player demographics and return-to-play data were obtained from the medical records. All available magnetic resonance images (MRIs) were reviewed by a musculoskeletal radiologist for specific imaging findings that correlated with return to play. RESULTS A total of 27 calf injuries in 24 NFL players were reviewed, yielding an incidence of 2.3 acute calf injuries per year on a single NFL team. Of these 27 injuries, 20 (74%) were isolated injuries to the gastrocnemius muscle, 4 (15%) were isolated injuries to the soleus muscle, and the remaining 3 injuries (11%) involved both. Defensive players were more likely to sustain injuries (P = .043). The mean time to return to play for all 27 players was 17.4 ± 14.6 days (range, 3-62 days). MRIs were available in 14 of the 27 injuries. The average size of the fascial defect (P = .032) and the presence of a fluid collection (P = .031) both correlated with return to play of longer than 2 weeks. CONCLUSION Although less common than hamstring or quadriceps muscle injuries, calf muscle injuries occur with relative frequency in the NFL, and more so in defensive players. The majority of these injuries occur in the gastrocnemius and result in significant disability, with at least 2 weeks of missed playing time on average. MRI may have an important role in the evaluation of calf injuries in NFL players, as certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of a fluid collection, are associated with longer return-to-play times after injury.
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Affiliation(s)
| | | | - Steve Kennelly
- New York Football Giants, East Rutherford, New Jersey, USA
| | - Leigh Weiss
- New York Football Giants, East Rutherford, New Jersey, USA
| | | | | | | | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
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