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

Beattie, Catherine E.; Barnett, Richard J.; Williams, Jennifer; Sim, Julius; Pullinger, Samuel A.

Abstract

Objectives
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 (RTP) times, compared to muscles injuries without intramuscular tendon involvement.

Design
Systematic review with meta-analysis.

Methods
Systematic review in accordance with PRISMA reporting guidelines. 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. Two authors independently screened results, extracted data and assessed study quality (QUIPS tool). A random-effects meta-analysis was performed on RTP days for British Athletics Muscle Injury Classification (BAMIC) ‘b’ vs ‘c’.

Results
On the QUIPS 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 RTP between injuries with or without intramuscular tendon involvement. Moderate evidence was found for an association between increased RTP time and the presence of “waviness” on MRI and loss of tendon tension, but no association with longitudinal extent of tendon involvement. Pooled analysis revealed a medium effect-size difference between BAMIC ‘b’ vs ‘c’ injuries, favouring BAMIC ‘b’ (Hedges g = 0.67; 95 % CI 0.20 to 1.15; P = 0.002).

Conclusions
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 (BAMIC ‘b’) over intratendinous injuries (BAMIC ‘c’).

• Journal Article Type: Review
• Acceptance Date: Oct 2, 2023
• Online Publication Date: Oct 5, 2023
• Publication Date: 2023-10
• Deposit Date: Oct 10, 2023
• Journal: Journal of Science and Medicine in Sport
• Print ISSN: 1440-2440
• Electronic ISSN: 1878-1861
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Issue: 11
• Pages: 599-609
• DOI: https://doi.org/10.1016/j.jsams.2023.10.002
• Keywords: Physical Therapy, Sports Therapy and Rehabilitation; Orthopedics and Sports Medicine
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1440244023004231?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Are return-to-play times longer in lower-limb muscle injuries involving the intramuscular tendon? A systematic review; Journal Title: Journal of Science and Medicine in Sport; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jsams.2023.10.002; Content Type: article; Copyright: © 2023 The Author(s). Published by Elsevier Ltd on behalf of Sports Medicine Australia.