Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes

Abstract

Background:Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied.Purpose:To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review of all acute calf muscle injuries on a single NFL team from 2003 to 2015 was performed. Player demographics and return-to-play data were obtained from the medical records. All available magnetic resonance images (MRIs) were reviewed by a musculoskeletal radiologist for specific imaging findings that correlated with return to play.Results:A total of 27 calf injuries in 24 NFL players were reviewed, yielding an incidence of 2.3 acute calf injuries per year on a single NFL team. Of these 27 injuries, 20 (74%) were isolated injuries to the gastrocnemius muscle, 4 (15%) were isolated injuries to the soleus muscle, and the remaining 3 injuries (11%) involved both. Defensive players were more likely to sustain injuries (P = .043). The mean time to return to play for all 27 players was 17.4 ± 14.6 days (range, 3-62 days). MRIs were available in 14 of the 27 injuries. The average size of the fascial defect (P = .032) and the presence of a fluid collection (P = .031) both correlated with return to play of longer than 2 weeks.Conclusion:Although less common than hamstring or quadriceps muscle injuries, calf muscle injuries occur with relative frequency in the NFL, and more so in defensive players. The majority of these injuries occur in the gastrocnemius and result in significant disability, with at least 2 weeks of missed playing time on average. MRI may have an important role in the evaluation of calf injuries in NFL players, as certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of a fluid collection, are associated with longer return-to-play times after injury.

Calf muscle strain injuries in elite Australian Football players: A descriptive epidemiological evaluation

“…The rate of same‐season re‐injury has ranged from 4% to 16% . Injury rates in the AFL are comparable to what has been reported in other codes, such as elite soccer and American football …”

“…Whilst we found gastrocnemius injuries to be less common in AFL players, such injuries appear to be more prevalent in other sports. For example, both Werner et al (investigating American football players) and Koulouris et al (investigating a mixed cohort of people) found gastrocnemius injuries to be more prevalent than soleus injuries. The prevalence of soleus vs gastrocnemius injuries may be somewhat sport‐dependent.…”

“…GREEN Et al. comparable to what has been reported in other codes, such as elite soccer and American football. 3,4 The AFL premiership season has three distinct stages: (1) the preseason, commencing in late October or November; (2) the competition season, made up of 22 weekly matches that begin in late March; and (3) a 4-week finals series. Matches are split into four quarters totaling approximately 120 minutes of which players typically participate in at least 80% of the total game time.…”

A Systematic Review of the Orthopaedic Literature Involving National Football League Players

“…Finally, calf injuries have been studied in NFL players, and 75% were isolated to the gastrocnemius, 15% to the soleus, and 10% to both muscles. 142 The mean time to RTP for calf injuries was 17 days, and 3 players required surgery. Larger fascial defects and the presence of fluid collection on MRI were associated with longer RTP.…”

Is It All About the Fascia? A Systematic Review and Meta-analysis of the Prevalence of Extramuscular Connective Tissue Lesions in Muscle Strain Injury

“…A total of 7 studies were identified that investigated the relationship of fascial injury and aspects of RTP (Table 4). 8,12,32,34,35,37,42 However, the applied statistical procedures and the objectives of the conducted analyses in the individual studies were too different to allow meta-analytic pooling of the results.…”