Are return-to-play times longer in lower-limb muscle injuries involving the intramuscular tendon? A systematic review.

OBJECTIVES: To determine the influence of severity and direction (craniocaudal length vs cross-sectional area) of intramuscular tendon tears in the lower limb on return-to-play times, compared to muscle injuries without intramuscular tendon involvement. DESIGN: Systematic review with meta-analysis. METHODS: AMED, CINAHL, SPORTDiscus, ScienceDirect, PubMed (MEDLINE) and Web-of-Science were searched from inception to 31st July 2023, retrieving 666 records, of which nine were deemed eligible. A random-effects meta-analysis was performed on time to return-to-play for British Athletics Muscle Injury Classification 'b' vs 'c'. RESULTS: On the Quality in Prognosis Studies tool, one study had low risk of bias and eight had high risk. Using a best-evidence synthesis, no strong evidence emerged for a difference in time to return-to-play between injuries with or without intramuscular tendon involvement. Moderate evidence was found for an association between increased return-to-play time and the presence of "waviness" on magnetic resonance imaging and loss of tendon tension, but no association with longitudinal extent of tendon involvement. Pooled analysis revealed a medium effect-size difference between British Athletics Muscle Injury Classification 'b' and 'c' injuries, favouring classification 'b' (Hedges g = 0.67; 95% confidence interval 0.20 to 1.15; P = 0.002). CONCLUSIONS: It remains difficult to provide an accurate prognosis for muscle injuries involving the intramuscular tendon due to high risk of bias and moderate heterogeneity across studies. Moderate evidence favoured the prognosis for injuries at the musculotendinous junction (British Athletics Muscle Injury Classification 'b') over intratendinous injuries (British Athletics Muscle Injury Classification 'c').

Laryngeal trauma: review of literature.

Laryngeal trauma is a rare injury that can lead to rapid airway deterioration if not treated in a timely, proper manner. Due to its infrequent occurrence, many different management strategies have evolved. All approaches stress an immediate stabilization of the airway, followed by a diagnostic protocol that demarcates different groupings based on the extent of laryngeal trauma. Treatment regimens, ranging from medical to surgical, are then based on such groupings. The uniformity of the management strategy mentioned above is misleading given the variation of management in the literature. This paper reviews the management strategy for laryngeal trauma, while detailing the different approaches described in the literature.