Skeletal Radiology

, Volume 46, Issue 11, pp 1513–1520 | Cite as

MRI detection of soleus muscle injuries in professional football players

  • G. PezzottaEmail author
  • G. Querques
  • A. Pecorelli
  • R. Nani
  • S. Sironi
Scientific Article



To describe magnetic resonance imaging (MRI) characteristics of soleus muscle injuries in symptomatic professional football players stratified according to both the Munich consensus statement and the British Athletics Muscle Injury Classification (BAMIC), and to investigate the association between specific MRI features and the “return to play” (RTP).

Materials and methods

Professional football players with an episode of acute posterior calf pain and impaired function, subsequent to sports activity, underwent ultrasound followed by MRI examination reviewed by two different radiologists with more than 10 years of experience in the musculoskeletal system. MRI features and RTP outcome were evaluated for all types of injuries.


During a 36-month period, a total of 20 professional football players were evaluated. According to the Munich consensus, 11 were type 3A, 8 were type 3B, and 1 was type 4, whereas according to the BAMIC, 11 lesions were considered grade 1, 4 grade 2, 4 grade 3, and 1 grade 4. RTP data were available for all patients (mean 3.3 ± 1.6 weeks). Both the Munich consensus and the BAMIC correlated with RTP (Spearman correlation = 0.982 and p < 0.0001 and 0.886 and p < 0.0001 respectively). Extension of edema was an independent prognostic factor for RTP in two different models of multivariate regression analysis (p = 0.044 model A; p = 0.031 model B).


The Munich consensus and BAMIC grading systems are useful tools for defining the patient’s prognosis and proper rehabilitation time after injury. The MRI feature that we should carefully look for is the extension of edema, as it seems to significantly affect the RTP.


Soleus injuries Professional football players Magnetic resonance Return to play 



We would like to thank Dr. Paolo Ferrero for his assistance in statistical analysis.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ekstrand J, Hägglund M, Waldén M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39(6):1226–32.CrossRefPubMedGoogle Scholar
  2. 2.
    Elias JJ, Faust AF, Chu YH, et al. The soleus muscle acts as an agonist for the anterior cruciate ligament. An in vitro experimental study. Am J Sports Med. 2003;31(2):241–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Hodgson JA, Finni T, Lai AM, et al. Influence of structure on the tissue dynamics of the human soleus muscle observed in MRI studies during isometric contractions. J Morphol. 2006;267(5):584–601.CrossRefPubMedGoogle Scholar
  4. 4.
    Garrett WE Jr. Muscle strain injuries. Am J Sports Med. 1996;24(6 Suppl):S2–8.PubMedGoogle Scholar
  5. 5.
    Balius R, Rodas G, Pedret C, et al. Soleus muscle injury: sensitivity of ultrasound patterns. Skeletal Radiol. 2014;43(6):805–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Koulouris G, Ting AYI, Jhamb A, et al. Magnetic resonance imaging findings of injuries to the calf muscle complex. Skeletal Radiol. 2007;36:921–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Lundgren JM, Davis BA. Endartery stenosis of the popliteal artery mimicking gastrocnemius strain: a case report. Arch Phys Med Rehabil. 2004;85(9):1548–51.CrossRefPubMedGoogle Scholar
  8. 8.
    Bencardino JT, Rosenberg ZS, Brown RR, et al. Traumatic musculotendinous injuries of the knee: diagnosis with MR imaging. Radiographics. 2000;20:S103–20.CrossRefPubMedGoogle Scholar
  9. 9.
    Koulouris G, Connell D. Hamstring muscle complex: an imaging review. Radiographics. 2005;25:571–86.CrossRefPubMedGoogle Scholar
  10. 10.
    Gilbert TJ Jr, Bullis BR, Griffiths HJ. Tennis calf or tennis leg. Orthopedics. 1996;19(2):179. 182, 184PubMedGoogle Scholar
  11. 11.
    Millar AP. Strains of the posterior calf musculature ("tennis leg"). Am J Sports Med. 1979;7(3):172–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Noya J, Sillero M. Incidencia lesional en el fútbol profesional español a lo largo de una temporada: días de baja por lesión. Apunts Med Esport. 2012;47(176):115–23.CrossRefGoogle Scholar
  13. 13.
    Orchard J, Best TM. The management of muscle strain injuries: an early return versus the risk of recurrence. Clin J Sport Med. 2002;12(1):3–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Orchard JW, Best TM, Mueller-Wohlfahrt HW, et al. The early management of muscle strains in the elite athlete: best practice in a world with a limited evidence basis. Br J Sports Med. 2008;42:158–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Brandser EA, el-Khoury GY, Kathol MH, et al. Hamstring injuries: radiographic, conventional tomographic, CT, and MR imaging characteristics. Radiology 1995;197:257–262.CrossRefPubMedGoogle Scholar
  16. 16.
    O'Donoghue DH. Treatment of injuries to athletes. Philadelphia: Saunders; 1984. p. 742.Google Scholar
  17. 17.
    Kerkhoffs GMMJ, van Es N, Wieldraaijer T, et al. Diagnosis and prognosis of acute hamstring injuries in athletes. Knee Surg Sports Traumatol Arthrosc. 2013;21:500–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Connell DA, Schneider-Kolsky ME, Hoving JL, et al. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol. 2004;183:975–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Ekstrand J, Healy JC, Waldén M, et al. Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med. 2012;46:112–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Askling CM, Tengvar M, Saartok T, et al. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med. 2006;35:197–206.CrossRefPubMedGoogle Scholar
  21. 21.
    Slavotinek J. Muscle injury: the role of imaging in prognostic assignment and monitoring of muscle repair. Semin Musculoskelet Radiol. 2010;14:194–200.CrossRefPubMedGoogle Scholar
  22. 22.
    Mueller-Wohlfahrt HW, Haensel L, Mithoefer K, et al. Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med. 2013;47(6):342–50.CrossRefPubMedGoogle Scholar
  23. 23.
    Pollock N, James SL, Lee JC, Chakraverty R. British athletics muscle injury classification: a new grading system. Br J Sports Med. 2014;48(18):1347–51.CrossRefPubMedGoogle Scholar
  24. 24.
    Hayashi D, Hamilton B, Guermazi A, et al. Traumatic injuries of thigh and calf muscles in athletes: role and clinical relevance of MR imaging and ultrasound. Insights Imaging. 2012;3(6):591–601.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Maffulli N, Oliva F, Frizziero A, et al. ISMuLT guidelines for muscle injuries. Muscles Ligaments Tendons J. 2014;3(4):241–9.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Balius R, Alomar X, Rodas G, et al. The soleus muscle: MRI, anatomic and histologic findings in cadavers with clinical correlation of strain injury distribution. Skeletal Radiol. 2013;42(4):521–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Pedret C, Rodas G, Balius R, et al. Return to play after soleus muscle injuries. Orthop J Sports Med. 2015;22:3(7).Google Scholar
  28. 28.
    Ekstrand J, Askling C, Magnusson H, et al. Return to play after thigh muscle injury in elite football players: implementation and validation of the Munich muscle injury classification. Br J Sports Med. 2013;47:769–74.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© ISS 2017

Authors and Affiliations

  • G. Pezzotta
    • 1
    Email author
  • G. Querques
    • 1
  • A. Pecorelli
    • 1
  • R. Nani
    • 1
  • S. Sironi
    • 1
  1. 1.Department of RadiologyPapa Giovanni XXIII Hospital, University Milano-BicoccaBergamoItaly

Personalised recommendations