Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update.

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.Systematic review with meta-analysis.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'.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).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'). 

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

Context: Muscle injury classification and grading systems have been reported for &gt;100 years; yet it offer limited evidence relating the clinical or radiological qualities of a muscle injury to the pathology or clinical outcome. The British Athletics Muscle Injury Classification (BAMIC) incorporates recent predictive features of muscle injuries and provides a precise radiographic framework for clinical prediction and management. Objective: To investigate clinical outcomes, particularly time to return to play (RTP), reinjury rate (RIR), and prognostic value of specific magnetic resonance imaging (MRI) findings, of activity-related muscle injuries (tears) in athletes after application of the BAMIC. Data Sources: A search of PubMed (NLM), EMBASE (Ovid), Web of Science (Clarivate), Cochrane Library (Wiley), and ClinicalTrials.gov from the inception date of each database through August 31, 2022, was conducted. Keywords included the BAMIC. Study Selection: All English language studies evaluating clinical outcomes of RTP and RIR after activity-related muscle injuries and where BAMIC was applied were included. A total of 136 articles were identified, and 11 studies met inclusion criteria. Study Design: Systematic review (PROSPERO: CRD42022353801). Level of Evidence: Level 2. Data Extraction: Two reviewers independently screened studies for eligibility and extracted data. Methodological quality of included study was assessed independently by 2 reviewers with the Newcastle-Ottawa Quality Scale (NOS); 11 good quality studies (4 prospective cohort studies, 7 retrospective cohort studies) with 468 athletes (57 female) and 574 muscle injuries were included. Results: All studies reported a statistically significant relationship between BAMIC grade, BAMIC injury site, and/or combined BAMIC grade and injury site with RTP. A statistically significant increased RIR was reported by BAMIC grade and BAMIC injury site in 2 of 4 and 3 of 4 studies, respectively. The prognostic value of individual MRI criteria was limited. Conclusion: Consistent evidence suggests that BAMIC offers prognostic and therapeutic guidance for clinical outcomes, particularly RTP and RIR, after activity-related muscle injuries in athletes that may be superior to previous muscle injury classification and grading systems. 

Outcomes of Activity-Related Lower Extremity Muscle Tears After Application of the British Athletics Muscle Injury Classification: A Systematic Review

Imaging of muscle injuries in soccer.

Hamstring strain injuries (HSI) are a common occurrence in athletics and complicated by limited prognostic indicators and high rates of reinjury. Assessment of injury characteristics at the time of injury (TOI) may be used to manage athlete expectations for time to return to sport (RTS) and mitigate reinjury risk. Magnetic resonance imaging (MRI) is routinely used in soft tissue injury management, but its prognostic value for HSI is widely debated. Recent advancements in musculoskeletal MRI, such as diffusion tensor imaging (DTI), have allowed for quantitative measures of muscle microstructure assessment. The purpose of this study was to determine the association of TOI MRI-based measures, including the British Athletic Muscle Injury Classification (BAMIC) system, edema volume, and DTI metrics, with time to RTS and reinjury incidence. Negative binomial regressions and generalized estimating equations were used to determine relationships between imaging measures and time to RTS and reinjury, respectively. Twenty-six index injuries were observed, with five recorded reinjuries. A significant association was not detected between BAMIC score and edema volume at TOI with days to RTS (p-values ≥ 0.15) or reinjury (p-values ≥ 0.13). Similarly, a significant association between DTI metrics and days to RTS was not detected (p-values ≥ 0.11). Although diffusivity metrics are expected to increase following injury, decreased values were observed in those who reinjured (mean diffusivity, p = 0.016; radial diffusivity, p = 0.02; principal effective diffusivity eigenvalues, p-values = 0.007-0.057). Additional work to further understand the directional relationship observed between DTI metrics and reinjury status and the influence of external factors is warranted. 

Association of quantitative diffusion tensor imaging measures with time to return to sport and reinjury incidence following acute hamstring strain injury

The British Athletics Muscle Injury Classification grading system as a predictor of return to play following hamstrings injury in professional football players.

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The British Athletics Muscle Injury Classification grading system as a predictor of return to play following hamstrings injury in professional football players.