Imaging-detected sports injuries and imaging-guided interventions in athletes during the 2022 FIFA football (soccer) World Cup.

OBJECTIVE: To describe imaging-detected musculoskeletal injuries and image-guided interventional procedures during the 2022 FIFA football (soccer) World Cup. MATERIALS AND METHODS: Retrospective analysis of all radiologic examinations performed in a central medical facility for athletes was performed by two board certified musculoskeletal radiologists. Data on muscle, tendon, ligament, cartilage, and bone injuries were collected according to imaging modality and body part. RESULTS: A total of 143 radiology examinations in 94 athletes were evaluated at the central medical facility. Magnetic resonance imaging (MRI) was the most utilized modality (67%), followed by radiography (12%), ultrasonography (9%), and computed tomography (4%). Image-guided interventions corresponded to 8% of all radiological examinations. There were 112 injuries described, affecting muscles and tendons (42%), ligaments (25%), cartilage (21%), and bone (12%). Most injured body parts were thigh (27%), foot and ankle (23%), knee (23%), and hip/groin (8%). Most injured players were within the age range of 24-35 years old (71%). CONCLUSION: Imaging was utilized in 11% of players who participated in the 2022 FIFA World Cup in Qatar. MRI was the most utilized modality, and acute muscle tears were the most diagnosed type of injury. Diagnostic imaging played an important role in diagnosing sports-related injuries during the 2022 FIFA World Cup.

Association Between Injury Mechanisms and Magnetic Resonance Imaging Findings in Rectus Femoris Injuries in 105 Professional Football Players.

OBJECTIVE: To describe the injury mechanism and its association with magnetic resonance imaging (MRI) injury findings in acute rectus femoris injuries. DESIGN: Combined retrospective and prospective descriptive injury study. Retrospective cohort from January 2010 to October 2013 and prospective cohort from October 2013 to January 2019. SETTING: Specialized sports medicine hospital. PARTICIPANTS: Male professional football players older than 18 years playing in a national football league, referred for injury assessment within 7 days after an acute rectus femoris injury, with a positive finding on MRI. INDEPENDENT VARIABLES: Rectus femoris muscle injury MRI findings in relation to injury mechanism in male football players. MAIN OUTCOME MEASURES: Rectus femoris injury mechanism (kicking, sprinting, and others), MRI injury location, and grade. RESULTS: There were 105 injuries in total, with 60 (57.1%) and 45 (42.8%) injuries from the retrospective and prospective cohorts, respectively. Kicking was the injury mechanism in 57 (54.3%) of all acute rectus femoris injuries, sprinting represented 32 (30.4%), and 16 (15.2%) were classified as others. There were 20 (19.05%) free tendon, 67 (63.8%) myotendinous junction and/or intramuscular tendon, and 18 (17.1%) peripheral myofascial located injuries. All free tendon injuries were related to kicking and graded as a complete tear of at least one of the tendons in 15/20 (75.0%) cases. CONCLUSIONS: Kicking seems to be an important mechanism related to complete ruptures and injuries occurring at the proximal free tendon. Sprinting was the other most common mechanism but was never associated with injury to the proximal free tendon.

High-resolution Ultrasound of the Foot and Ankle.

High-resolution ultrasound (US) can be used to assess soft tissue abnormalities in the foot and ankle. Compared to MRI, it has lower cost, is widely available, allows portability and dynamic assessment. US is an excellent method to evaluate foot and ankle tendon injuries, ligament tears, plantar fascia, peripheral nerves, and the different causes of metatarsalgia.

Imaging of Muscle Injuries: MR Imaging-Ultrasound Correlation.

Ultrasound (US) and MR imaging are the most common imaging modalities used to assess sports muscle injuries. The site of the muscle injury can be located at the peripheral aspect of the muscle (myofascial), within the muscle belly (musculotendinous), and with tendon involvement (intratendinous). Tears that affect the intramuscular tendon have a worse prognosis in terms of recovery time. US is an excellent method to evaluate muscle injuries, with high spatial and contrast resolution. MR imaging can be reserved for evaluation of professional athletes, surgical planning, differential diagnosis, and assessment of deep located and proximal muscle groups.

Associations between clinical findings and MRI injury extent in male athletes with acute adductor injuries - A cross-sectional study.

OBJECTIVES: To investigate the association between clinical assessment and MRI measures of oedema and MRI grading in male athletes with acute adductor injuries. DESIGN: Cross-sectional study. METHODS: We included 81 consecutive athletes with acute adductor injuries. All athletes received a standardized clinical assessment and magnetic resonance imaging (MRI), blinded to clinical information. We analysed correlations between extent of palpation pain and extent of MRI oedema for the adductor longus. We compared the clinical assessment to MRI adductor injury grading (0-3) using ordinal regression. We analysed positive and negative predictive values (PPV/NPV) of a complete adductor longus avulsion. RESULTS: Proximal-distal length of adductor longus palpation pain had fair correlation with MRI proximal-distal oedema length oedema (r=0.309, p=0.022). Cross-sectional surface area of palpation pain had poor correlation with corresponding cross-sectional MRI oedema area (r=0.173, p=0.208). The symptoms subscale of the Copenhagen Hip And Groin Outcome Score (HAGOS) for the period since injury (log odds ratio=0.97, p=0.021) and passive adductor stretch pain (log odds ratio=0.35, p=0.046) were associated with MRI injury grading. If there was a palpable defect, MRI always showed a complete avulsion (PPV=100%). Several tests had high negative predictive values: passive adductor stretch (100%), palpation pain at the adductor longus insertion (98%), and the FABER test (98%). CONCLUSIONS: The extent of palpation pain does not indicate the extent of MRI oedema in acute adductor longus injuries. A worse modified HAGOS symptoms subscale score and passive adductor stretch pain indicate a higher MRI adductor injury grade. Clinical examination tests have high ability to detect or rule out a complete adductor longus avulsion on MRI.

Associations Between Initial Clinical Examination and Imaging Findings and Return-to-Sport in Male Athletes With Acute Adductor Injuries: A Prospective Cohort Study.

BACKGROUND: Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance. PURPOSE: To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries. STUDY DESIGN: Cohort study (Prognosis); Level of evidence, 2. METHODS: Male adult athletes with an acute adductor injury were included within 7 days of injury. Standardized patient history and clinical and magnetic resonance imaging (MRI) examinations were conducted for all athletes. Athletes performed a supervised standardized criteria-based exercise treatment program. Three RTS milestones were defined: (1) clinically pain-free, (2) completed controlled sports training, and (3) first full team training. Univariate and multiple regression analyses were performed to determine the association between the specific candidate variables of the initial examinations and the RTS milestones. RESULTS: We included 81 male adult athletes. The median duration for the 3 RTS milestones were 15 days (interquartile range, 12-28 days), 24 days (16-32 days), and 22 days (15-31 days), respectively. Clinical examination including patient history was able to explain 63%, 74%, and 68% of the variance in time to RTS. The strongest predictors for longer time to RTS were pain on palpation of the proximal adductor longus insertion or a palpable defect. The addition of MRI increased the explained variance with 7%, 0%, and 7%. The strongest MRI predictor was injury at the bone-tendon junction. Post hoc multiple regression analyses of players without the 2 most important clinical findings were able to explain 24% to 31% of the variance, with no added value of the MRI findings. CONCLUSION: The strongest predictors of a longer time to RTS after acute adductor injury were palpation pain at the proximal adductor longus insertion, a palpable defect, and/or an injury at the bone-tendon junction on MRI. For athletes without any of these findings, even extensive clinical and MRI examination does not assist considerably in providing a more precise estimate of time to RTS.