Skip to main content
SpringerLink
Log in

MRI assessment of calf injuries in Australian Football League players: findings that influence return to play

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Orchard J, Seward H, Orchard J. 23rd Annual AFL Injury Report: 2014.

  2. Elkstrand J, Healy JC, Walden M, Lee JC, English B, Hagglund M. Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med. 2012;46:112–7.

    Article  Google Scholar 

  3. Elliot MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10 year review. Am J Sports Med. 2011;39:843–50.

    Article  Google Scholar 

  4. De Smet AA, Best TM. MR Imaging in the distribution and location of acute hamstring injuries in athletes. AJR Am J Roentgenol. 2000;174:393–400.

    Article  PubMed  Google Scholar 

  5. Slavotinek JP, Verrall GM, Fon GT. Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition. AJR Am J Roentgenol. 2002;179:1621–8.

    Article  PubMed  Google Scholar 

  6. Comin J, Malliaris P, Baquie P, Barbour T, Connell D. Return to competitive play after hamstring injuries involving disruption of the central tendon. Am J Sports Med. 2013;41:111–5.

    Article  PubMed  Google Scholar 

  7. Pomeranz SJ, Heidt RS. MR imaging in the prognostication of hamstring injury. Work in progress. Radiology. 1993;189:897–900.

    Article  CAS  PubMed  Google Scholar 

  8. Balius R, Alomar X, Rodas G, Miguel-Perez M, Pedret C, Dobado MC, et al. The soleus muscle: MRI, anatomic and histologic findings in cadavers with clinical correlation of strain injury distribution. Skeletal Radiol. 2013;42:521–30.

    Article  PubMed  Google Scholar 

  9. Aughey R. Australian football player work rate: evidence of fatigue and pacing? Int J Sports Physiol Perform. 2010;5:394–405.

    Article  PubMed  Google Scholar 

  10. Lee JC, Mitchell AWM, Healy JC. Imaging of muscle injury in the elite athlete. Br J Radiol. 2012;85:1173–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Pedret C, Rodas G, Balius R, et al. Return to play after soleus muscle injuries. Orthop J Sports Med. 2015;3(7):2325967115595802.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Orchard J, Best TM, Verrall GM. Return to play following muscle strains. Clin J Sport Med. 2005;15:436–41.

    Article  PubMed  Google Scholar 

  13. Delgado GJ, Ching CB, Lektrakul N, Azocar P, Botte MJ, Coria D, et al. Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology. 2002;224(1):112–9.

    Article  PubMed  Google Scholar 

  14. Koulouris G, Ting A, Jhamb A, Connell D, Kavanagh EC. Magnetic resonance imaging findings of injuries to the calf muscle complex. Skeletal Radiol. 2007;36:921–7.

    Article  PubMed  Google Scholar 

  15. Palmer WE, Kuong SJ, Elmadbouh HM. MR imaging of myotendinous strain. AJR Am J Roentgenol. 1999;173:703–9.

    Article  CAS  PubMed  Google Scholar 

  16. Garrett Jr WE. Muscle strain injuries. Am J Sports Med. 1996;24(6 Suppl):S2–8.

    PubMed  Google Scholar 

  17. Cross TM, Gibbs N, Houang MT, Cameron M. Acute quadriceps muscle strains: magnetic resonance imaging features and prognosis. Am J Sports Med. 2004;32:710–9.

    Article  PubMed  Google Scholar 

  18. Frank C, Shrive N, Lo I, Hart D. Form and function of a tendon and ligament. In: Einhorn T, O’Keefe R, Buckwalter J, editors. Orthopaedic basic science: foundations of clinical practice. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2007. p. 191–222.

    Google Scholar 

  19. Connell DA, Schneider-Kolsky ME, Hoving JL, Malara F, Buchbinder R, Koulouris G, et al. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstrings injuries. AJR Am J Roentgenol. 2004;183:975–84.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the members of the AFL Medical Officers Association and Dr John Orchard. We also thank the MRI staff at Victoria House Medical Imaging.

Author information

Authors and Affiliations

  1. Victoria House Medical Imaging, 316 Malvern Road, Prahran, 3181, Victoria, Australia

    George Waterworth, Sara Wein & Andrew H. Rotstein

  2. Melbourne Epicentre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia

    Alexandra Gorelik

Authors
  1. George Waterworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Wein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandra Gorelik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew H. Rotstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara Wein.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Waterworth, G., Wein, S., Gorelik, A. et al. MRI assessment of calf injuries in Australian Football League players: findings that influence return to play. Skeletal Radiol 46, 343–350 (2017). https://doi.org/10.1007/s00256-016-2564-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-016-2564-7

Keywords

Search

Navigation