MRI Findings Associated With Anterior Cruciate Ligament Tears in National Football League Athletes.

Background: Anterior cruciate ligament (ACL) tears are a high-frequency injury requiring a lengthy recovery in professional American football players. Concomitant pathology associated with ACL tears as identified on magnetic resonance imaging (MRI) is not well understood in these athletes. Purpose: To describe the MRI findings of concomitant injuries associated with ACL tears among athletes in the National Football League (NFL). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Of 314 ACL injuries in NFL athletes from 2015 through 2019, 191 complete MRI scans from the time of primary ACL injury were identified and reviewed by 2 fellowship-trained musculoskeletal radiologists. Data were collected on ACL tear type and location, as well as presence and location of bone bruises, meniscal tears, articular cartilage pathology, and concomitant ligament pathology. Mechanism data from video review were linked with imaging data to assess association between injury mechanism (contact vs noncontact) and presence of concomitant pathology. Results: Bone bruises were evident in 94.8% of ACL tears in this cohort, most often in the lateral tibial plateau (81%). Meniscal, additional ligamentous, and/or cartilage injury was present in 89% of these knees. Meniscal tears were present in 70% of knees, lateral (59%) more than medial (41%). Additional ligamentous injury was present in 71% of all MRI scans, more often a grade 1/2 sprain (67%) rather than a grade 3 tear (33%), and most often involving the medial collateral ligament (MCL) (57%) and least often the posterior cruciate ligament (10%). Chondral damage was evident in 49% of all MRI scans, with ≥1 full-thickness defect in 25% of all MRI scans, most often lateral. Most (79%) ACL tears did not involve direct contact to the injured lower extremity. Direct contact injuries (21%) were more likely to have a concomitant MCL tear and/or medial patellofemoral ligament injury and less likely to have a medial meniscal tear. Conclusion: ACL tears were rarely isolated injuries in this cohort of professional American football athletes. Bone bruises were almost always present, and additional meniscal, ligamentous, and chondral injuries were also common. MRI findings varied by injury mechanism.

Imaging of Turf Toe.

During the advent of artificial turf and flexible footwear in football, turf toe was initially coined and described as a 1st metatarsophalangeal joint sprain injury. In the classic setting of hyperextension of the 1st metatarsophalangeal joint, turf toe is an injury to its plantar capsuloligamentous complex. Advances in MR imaging and knowledge of the complex 1st metatarsophalangeal joint help pinpoint the injured plantar structures as well as assess severity and chronicity of the injury. Detailed analysis of turf toe should highlight the best conservative and surgical options for injured athletes to reach optimal recovery.

Imaging and ultrasound-guided steroid injection of internal oblique muscle strains in baseball pitchers.

BACKGROUND: Internal oblique muscle injuries are common in professional baseball pitchers and may require a prolonged convalescence of up to 10 weeks. Most strains can be diagnosed clinically, but imaging can be helpful to assess the severity of injury, which may predict recovery and return to play. HYPOTHESIS: Ultrasound-guided injection of steroid and local anesthetic into the muscle tear can speed recovery and subsequent return to play. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Three professional baseball pitchers with acute tears of the internal oblique muscle confirmed by magnetic resonance imaging underwent ultrasound-guided injection of steroid and local anesthetic. RESULTS: All 3 patients experienced significant pain relief within a few days of the injection and were able to pitch at full speed within 3 weeks of injury (mean, 21 days) and return to able status by 5 weeks (mean, 30.7 days). The 3 athletes continue to pitch in Major League Baseball 36 months, 36 months, and 14 months, respectively, after injury, and none have sustained reinjury during this time. CONCLUSION: Therapeutic injection of steroids and anesthetic under ultrasound guidance appears to speed recovery and rehabilitation in professional baseball pitchers with acute side strains.

Treatment of magnetic resonance imaging-documented isolated grade III lateral collateral ligament injuries in National Football League athletes.

BACKGROUND: Isolated high-grade tears of the lateral collateral ligament (LCL) of the knee are rare, as most injuries are part of a broader pattern of damage to the posterolateral corner. Limited data exist in the literature about the ideal management of isolated LCL injuries, especially in elite-level athletes. HYPOTHESIS: Operative and nonoperative treatment of MRI-documented isolated grade III LCL injury can produce equal results in terms of return to play in the National Football League (NFL). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The NFL Injury Surveillance System was used to identify all players with lateral ligament injuries of the knee from 1994 to 2004. In addition, the medical staffs of all NFL clubs were surveyed about injuries during the same period. Nine players with MRI-documented isolated grade III LCL injuries were identified through this process. The medical staff for each respective player then completed a data questionnaire. Statistics were analyzed using 1-way analysis of variance. RESULTS: Four players underwent direct surgical repair of their injuries; they missed an average of 14.5 weeks of play and did not return within the same season. Five players were managed nonoperatively and missed an average of 2.0 weeks (P = .0001). Four of the 5 players in the nonoperative group returned within the same season at an average of 10 days; 1 missed the rest of the season. All 9 players were able to return to play the following season, and played for an average total of 2.8 (operative) and 4.4 (nonoperative) additional seasons (P = .253). CONCLUSION: Nonoperative management of MRI-documented isolated grade III lateral collateral ligament injuries in NFL athletes results in more rapid return to play without subjecting the player to the risks of surgery, while achieving an equal likelihood of return to play at the professional level.

MR imaging of turf toe.

MR imaging provides soft tissue detail unparalleled by any other modality for the assessment of turf toe injuries and has become standard in certain populations of athletic patients. Principal knowledge of the anatomy and appropriate imaging techniques is central for accurate imaging evaluation. The precise determination of the structures involved and the severity of the injury by MR imaging provides the basis for treatment.