Sports Injury of the Lower Extremity: Role of Imaging in Diagnosis and Management

The lower limb is susceptible to injury in almost all sports, but it is the most common cause of absence from the field of play in athletic activity dominated by the lower limbs.

The most frequent injuries are a consequence of overuse, but contact and noncontact trauma, especially involving the joints, leads to the longest time out of competition. The musculoskeletal radiologist has a pivotal role in the diagnosis, prognostication, and ultimately in the management and rehabilitation of lower limb athletic sports injuries. Making the correct diagnosis is essential, but helping clinicians predict time out from competitive activity and contributing to the management and rehabilitation of the athlete are becoming more important challenges.

Responding to these challenges requires understanding of the clinical problems and their relationship to radiological findings. Multidisciplinary discussion with all the involved clinicians, including physiotherapists, physicians, and surgeons, using the same terminology and clinically correlating radiological findings will ensure the best possible prognostication, management plan, and rehabilitation for the injured athlete.

In this issue of Seminars in Musculoskeletal Radiology we solicited articles from radiologists with a large professional sports practice in the United Kingdom and encouraged them to coauthor with physicians and surgeons who also are involved in professional lower limb–dominated sport.

The subjects we chose represent common lower limb sports injuries that can be challenging management problems for our clinical colleagues. We asked our authors to make the articles clinically relevant and to discuss the role of imaging both in the assessment and management of these injuries because radiology is increasingly being used to deliver therapies that contribute to management and rehabilitation.

In the first two articles, Ansede and Robinson with their respective coauthors discuss the causes of groin pain. The first article demonstrates the need for a wide field-of-view perspective for this presentation, but clinical findings are also essential in helping focus radiology and may influence the choice of magnetic resonance (MR) examination. The second article deals with the controversial clinical and radiological area of central pubalgia, a common and debilitating symptom in sports characterized by twisting and turning. It reviews the clinical, anatomical, and biomechanical basis of pubalgia and discusses image-guided interventions.

Douis and coauthors discuss muscle injury, the most common injury in lower limb–dominated sports. Imaging is now central in the diagnosis and prognostication of muscle injury in professional sport, allowing sports physicians to tailor treatment and rehabilitation and thus reduce the period for return to play.

Rajeswaran et al discuss the role of imaging in the diagnosis and consequently the management of multiligament injury of the knee, a challenging orthopedic scenario that can risk the future participation of athletes in elite sport.

Gupta and coauthors discuss the extra-articular causes of knee pain in athletes, which are frequently caused by overuse. Their article emphasizes the usefulness of musculoskeletal sonography in dynamic assessment and in directing diagnostic and therapeutic injections.

Hughes and Houlihan-Burne discuss sports-related cartilage injuries in the knee. They review the MRI appearances of cartilage injury, elegantly illustrate the surgical techniques, and finally discuss postsurgical MR appearances.

Wijesekera and coauthors discuss the best imaging approach for assessing Achilles tendinopathy and peritendinitis. The optimal treatment for chronic noninsertional Achilles tendinopathy remains an enigma. Radiologists increasingly are asked to intervene for athletes who fail conservative treatment. The authors discuss the various sonographically guided percutaneous treatments and the last resort of surgical management for this most challenging of overuse injuries.

In the final article, Teh et al provide an overview of the role of imaging in the assessment and management of overuse injuries in the foot and ankle. This relatively small anatomical area is the source of a plethora of pathologies in lower limb–dominated sports and can be difficult to distinguish clinically. Imaging is essential in helping define the source of symptoms and effectively direct diagnostic and therapeutic injections that aid in management and rehabilitation.

We would like to extend our appreciation to all the contributors, especially the clinicians who helped us maintain a clinical focus in these articles. We must always remember that we are, after all, clinical radiologists.

Finally, we would like to thank the editors and publisher of Seminars in Musculoskeletal Radiology for inviting us to serve as guest editors and share our experience of sports injury of the lower extremity in the United Kingdom.