E³ 221 - MR imaging in sports medicine I
1. To understand the anatomy of the most common injured muscles.
2. To learn the evaluation of muscle injuries and the impact regarding recovery.
According to the UEFA injury study 2014, almost 50% of all injuries in professional soccer players are related to muscles, tendon and the musculotendinous junction. During this lecture, you will learn how normal and injured muscle will look like. The standard imaging protocol is including axial T1- and fsPD sequences, angulated coronal and sagittal fsPD sequences with a slice thickness between 1 and 6 mm. You will learn to differentiate between functional muscle disorders without structural injuries (like fatigue-induced muscle disorder (Type 1a), delayed-onset muscle soreness (Type 1b) and spine (Type 2a) or muscle-related neuromuscular disorder (Type 2b)) and structural injuries (minor partial tear (Type 3a), moderate partial tear (Type 3b) and total/subtotal tear (Type 4) of the muscle, the musculotendinous junction and tendinous avulsion). Most structural injuries are stretch-induced injuries and have to be differentiated from contusion injury and distraction injury. In soccer, 92% of all muscle injuries affect the four major muscle groups of the lower limbs (hamstrings, adductors, quadriceps and calf muscles) and occur mainly in non-contact situations.
1. To learn the anatomy of the most common injured structures.
2. To recognise typical combinations of injuries.
The main stabilizer of the medial retinaculum is the medial patellofemoral ligament (MPFL). The MPFL is intimately related to the vastus medialis obliquus muscle and its femoral insertion is located in between the medial epicondyle and the adductor tubercle. Injuries of the MPFL may occur at the patellar or femoral insertion. Typical patterns of bone contusions of patellar dislocation include edema in the medial aspect of the patella and anterolateral femoral condyle. When patellar dislocation occurs with the knee flexed, the bone marrow edema is located more along the mid aspect of the lateral femoral condyle. The medial supporting structures are made up of the MCL and posterior oblique ligament, the MCL being a three-layered structure. Patterns of bone marrow edema due to valgus trauma include lateral bone contusions. The semimembranosus is the main stabilizer along the posteromedial corner, but injuries of this structure are rare. The anterior cruciate ligament is made up of two bundles and injuries are typically associated with bone marrow edema along the lateral condyle and posterolateral tibia. Segond avulsion is a characteristic bony avulsion along the lateral tibia, at the insertion site of the iliotibial band and anterolateral ligament. The posterolateral corner includes the arcuate, popliteofibular and fabellofibular ligaments. Injuries may lead to the 'arcuate sign' and anteromedial bone contusions. O' Donoghue's triad is a characteristic association of medial meniscus, ACL and MCL lesions.