Lower limb muscle injuries: The good, the bad and the ugly

Mechanisms of Hamstring Injury in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings

OBJECTIVE

To describe the injury mechanisms and magnetic resonance imaging (MRI) findings in acute hamstring injuries of male soccer players using a systematic video analysis.

DESIGN

Descriptive case series study of consecutive acute hamstring injuries from September 2017 to January 2022.

SETTING

Two specialized sports medicine hospitals.

PARTICIPANTS

Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after an acute hamstring injury, with an available video footage of the injury and positive finding on MRI.

INDEPENDENT VARIABLES

Hamstring injury mechanisms (specific scoring based on standardized models) in relation to hamstring muscle injury MRI findings.

MAIN OUTCOME MEASURES

Hamstring injury mechanism (playing situation, player/opponent behavior, movement, and biomechanical body positions) and MRI injury location.

RESULTS

Fourteen videos of acute hamstring injuries in 13 professional male soccer players were analyzed. Three different injury mechanisms were seen: mixed-type (both sprint-related and stretch-related, 43%), stretch-type (36%), and sprint-type (21%). Most common actions during injury moments were change of direction (29%), kicking (29%), and running (21%). Most injuries occurred at high or very high horizontal speed (71%) and affected isolated proximal biceps femoris (BF) (36%). Most frequent body positions at defined injury moments were neutral trunk (43%), hip flexion 45-90 degrees (57%), and knee flexion <45 degrees (93%). Magnetic resonance imaging findings showed that 79% were isolated single-tendon injuries.

CONCLUSIONS

According to a video analysis, most hamstring injuries in soccer occur during high-speed movements. Physicians should suspect proximal and isolated single-tendon-most often BF-hamstring injury, if represented injury mechanisms are seen during game play. In addition to sprinting and stretching, also mixed-type injury mechanisms occur.

Imaging in international sporting event: experience from the Birmingham Commonwealth Games 2022

AIM

To explain the design and delivery of diagnostic imaging and image-guided intervention services for an international games. The authors share their experiences from the Birmingham Commonwealth Games 2022.

MATERIALS AND METHODS

A retrospective analysis was undertaken of anonymised data from the Zillion, Easyvision (RIS and PACS), and Encounter platforms for image viewing, interpretation and reporting during the Games. The data collected included age and gender, type of sport, nature of the injury, and imaging findings with diagnoses.

RESULTS

The number of individuals who had radiological investigations at the Birmingham Commonwealth Games was 518 and the vast majority of them were athletes (90 %). The average age of athletes who had imaging was 28 years and that of non-athletes who accessed imaging services was 46.4 years with male predominance. Magnetic resonance imaging was the most frequently used imaging technique and the lower limb was the most frequently imaged body part. Athletes playing netball and beach volleyball had the highest percentage of injuries.

CONCLUSION

The authors share their experience from the Birmingham Commonwealth Games 2022 regarding the nuances and challenges in radiology service provision for an international sports event that would be helpful for musculoskeletal radiologists in the design and delivery of similar international events in the future.

Research on skeletal muscle impact injury using a new rat model from a bioimpact machine

Introduction: Skeletal muscle impact injury occurs frequently during sports, falls, and road traffic accidents. From the reported studies on skeletal muscle injury, it is difficult to determine the injury parameters. Therefore, we developed a new model of gastrocnemius impact injury in rats with a bioimpact machine, with which the experimental operation could be conducted in feasibility from the recorded parameters. Through this novel model, we study the skeletal muscle impact injury mechanisms by combining temporal and spatial variation. Methods: The gastrocnemius of anesthetized rats was injured by a small pneumatic-driven bioimpact machine; the moving speed and impact force were determined, and the whole impact process was captured by a high-speed camera. We observed the general condition of rats and measured the changes in injured calf circumference, evaluating calf injuries using MRI, gait analysis system, and pathology at different times after the injury. Results: The gastrocnemius was injured at an impact speed of 6.63 m/s ± 0.25 m/s and a peak force of 1,556.80 N ± 110.79 N. The gait analysis system showed that the footprint area of the RH limb decreased significantly on the first day and then increased. The calf circumference of the injured limb increased rapidly on the first day post-injury and then decreased in the next few days. MRI showed edema of subcutaneous and gastrocnemius on the first day, and the area of edema decreased over the following days. HE staining showed edema of cells, extensive hyperemia of blood vessels, and infiltration of inflammatory cells on the first day. Cell edema was alleviated day by day, but inflammatory cell infiltration was the most on the third day. TEM showed that the sarcoplasmic reticulum was dilated on the first day, the mitochondrial vacuolation was obvious on the second day, and the glycogen deposition was prominent on the fifth day. Conclusion: In our experiment, we developed a new and effective experimental animal model that was feasible to operate; the injured area of the gastrocnemius began to show "map-like" changes in the light microscope on the third day. Meanwhile, the gastrocnemius showed a trend of "edema-mitochondrial vacuolation-inflammatory cell aggregation" after impact injury.

Interval Kicking Program for the Punting and Place-Kicking Athlete: A Systematic Literature Review and Need Analysis

Interval programs have been developed for multiple sports, allowing athletes to return to sport-specific activity in a graded fashion, minimizing the risk of reinjury. However, there currently exists a gap in the literature surrounding the use of interval programs for the rehabilitation of punting and place-kicking athletes. We aim to perform a systematic review of the literature examining the use of interval kicking programs to aid punting and place-kicking athletes following a lower-extremity injury. Following PRISMA guidelines, a review was performed using PubMed and MEDLINE databases to evaluate the literature surrounding interval kicking programs for punting and place-kicking athletes. Search terms were combined using Boolean operators of "AND" and "OR". Articles included in this review met these criteria: 1) included patients with lower-extremity pain/injury, 2) reported a return to sport progressive program, and 3) analyzed the measure's ability to predict a successful return to sport. The initial search returned 115 articles. Seventy-nine of these articles were excluded after initial screening, leaving 36 full-text articles for final review. Of these final articles, there were no studies outlining the use of interval kicking programs by punting or place-kicking athletes. Of the articles reviewed, the most relevant was an interval kicking program developed by Arundale et al. specifically for the soccer athlete. Punting and place-kicking use biomechanically distinct patterns of movement, warranting a specific interval program. This review identified a gap in knowledge surrounding the use of interval programs in the rehabilitation of punting and place-kicking athletes. This review will now describe what is currently known regarding biomechanics of punting and place kicking, the injuries experienced by these athletes, and the benefit an individualized interval program could provide. There currently exists a gap in the literature surrounding the use of interval programs for the rehabilitation of punting and place-kicking athletes. The biomechanics and application of these skills are distinct, and an interval program designed specifically for these athletes is warranted. Future research should be dedicated to the development, implementation, and analysis of an interval kicking program designed for these athletes.

Muscle Madness and Making a Case for Muscle-Specific Classification Systems: A Leap from Tissue Injury to Organ Injury and System Dysfunction

Despite the recent publication and subsequent clinical application of several muscle injury classification systems, none has been able to address the varying and often unique/complex types of injuries that occur in different muscles. Although there are advantages of using a unified classification, there are significant differences between certain muscles and muscle groups. These differences may complicate the clinical effectiveness of using a unified injury classification. This narrative explores the difficulties in using a single classification to describe the heterogeneous nature of muscle injuries. Within that context, the possibility of viewing muscles and muscle injuries in the same manner as other biological tissues, structures, organs, and systems is discussed. Perhaps, in addition to a unified classification, subclassifications or muscle specific classifications should be considered for certain muscles. Having a more specific (granular) approach to some of the more commonly injured muscles may prove beneficial for more accurately and effectively diagnosing and treating muscle injuries. Ideally, this will also lead to more accurate determination of the prognosis of specific muscle injuries.

Engineering complex muscle-tissue interfaces through microfabrication

Skeletal muscle is a tissue with a complex and hierarchical architecture that influences its functional properties. In order to exert its contractile function, muscle tissue is connected to neural, vascular and connective compartments, comprising finely structured interfaces which are orchestrated by multiple signalling pathways. Pathological conditions such as dystrophies and trauma, or physiological situations such as exercise and aging, modify the architectural organization of these structures, hence affecting muscle functionality. To overcome current limitations of in vivo and standard in vitro models, microfluidics and biofabrication techniques have been applied to better reproduce the microarchitecture and physicochemical environment of human skeletal muscle tissue. In the present review, we aim to critically discuss the role of those techniques, taken individually or in combination, in the generation of models that mimic the complex interfaces between muscle tissue and neural/vascular/tendon compartments. The exploitation of either microfluidics or biofabrication to model different muscle interfaces has led to the development of constructs with an improved spatial organization, thus presenting a better functionality as compared to standard models. However, the achievement of models replicating muscle-tissue interfaces with adequate architecture, presence of fundamental proteins and recapitulation of signalling pathways is still far from being achieved. Increased integration between microfluidics and biofabrication, providing the possibility to pattern cells in predetermined structures with higher resolution, will help to reproduce the hierarchical and heterogeneous structure of skeletal muscle interfaces. Such strategies will further improve the functionality of these techniques, providing a key contribution towards the study of skeletal muscle functions in physiology and pathology.

Fasciae of the musculoskeletal system: MRI findings in trauma, infection and neoplastic diseases

The fascial system is a continuum of connective tissues present everywhere throughout the body that can be locally involved in a large variety of disorders. These disorders include traumatic disorders (Morel-Lavallée lesion, myo-aponeurotic injuries, and muscle hernia), septic diseases (necrotizing and non-necrotizing cellulitis and fasciitis), and neoplastic diseases (superficial fibromatosis, desmoid tumors, and sarcomas). The current pictorial review aims to focus on these localized disorders involving the fasciae of the musculoskeletal system and their appearance at MRI.