Classification systems for assessing acute muscle injuries: a retrospective comparison of inter-reader agreements

Edouard P, Branco P, Alonso JM. Muscle injury is the principal injury type and hamstring muscle injury is the first injury diagnosis during top-level international athletics championships between 2007 and 2015. Br J Sports Med. 2016;50(10):619–30.

PubMed  Google Scholar 

Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39(6):1226–32.

PubMed  Google Scholar 

Orchard JW, Seward H, Orchard JJ. Results of 2 decades of injury surveillance and public release of data in the Australian Football League. Am J Sports Med. 2013;41(4):734–41.

PubMed  Google Scholar 

Elliott MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med. 2011;39(4):843–50.

PubMed  Google Scholar 

Brooks JH, Fuller CW, Kemp SP, Reddin DB. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med. 2006;34(8):1297–306.

PubMed  Google Scholar 

Ouellette H, Thomas BJ, Nelson E, Torriani M. MR imaging of rectus femoris origin injuries. Skeletal Radiol. 2006;35(9):665–72.

PubMed  Google Scholar 

Geiss Santos RC, Van Hellemnondt F, Yamashiro E, Holtzhausen L, Serner A, Farooq A, et al. Association between injury mechanisms and magnetic resonance imaging findings in rectus femoris injuries in 105 professional football players. Clin J Sport Med. 2022;32(4):e430–5.

PubMed  Google Scholar 

Kassarjian A, Rodrigo RM, Santisteban JM. Intramuscular degloving injuries to the rectus femoris: findings at MRI. AJR Am J Roentgenol. 2014;202(5):W475-480.

PubMed  Google Scholar 

Crema MD, Yamada AF, Guermazi A, Roemer FW, Skaf AY. Imaging techniques for muscle injury in sports medicine and clinical relevance. Curr Rev Musculoskelet Med. 2015;8(2):154–61.

PubMed  PubMed Central  Google Scholar 

Chang JS, Kayani B, Plastow R, Singh S, Magan A, Haddad FS. Management of hamstring injuries: current concepts review. Bone Joint J. 2020;102-B(10):1281–1288.

Heiss R, Tol JL, Pogarell T, Roemer FW, Reurink G, Renoux J, et al. Imaging of muscle injuries in soccer. Skeletal Radiol. 2025;54(4):655–67.

PubMed  Google Scholar 

Hirahata Y, Yasui Y, Sasahara J, Inui T, Nakagawa T, Kawano H, Miyamoto W. Role of ultrasonography and MRI in acute hamstring strains: diagnostic and prognostic insights. Diagnostics (Basel). 2025. https://doi.org/10.3390/diagnostics15091053.

Moen MH, Reurink G, Weir A, Tol JL, Maas M, Goudswaard GJ. Predicting return to play after hamstring injuries. Br J Sports Med. 2014;48(18):1358–63.

CAS  PubMed  Google Scholar 

Jacobsen P, Witvrouw E, Muxart P, Tol JL, Whiteley R. A combination of initial and follow-up physiotherapist examination predicts physician-determined time to return to play after hamstring injury, with no added value of MRI. Br J Sports Med. 2016;50(7):431–9.

PubMed  Google Scholar 

Wangensteen A, Almusa E, Boukarroum S, Farooq A, Hamilton B, Whiteley R, et al. MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: a prospective cohort of 180 male athletes. Br J Sports Med. 2015;49(24):1579–87.

PubMed  Google Scholar 

Guermazi A, Roemer FW, Robinson P, Tol JL, Regatte RR, Crema MD. Imaging of muscle injuries in sports medicine: sports imaging series. Radiology. 2017;285(3):1063.

PubMed  Google Scholar 

Ekstrand J, Askling C, Magnusson H, Mithoefer K. 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(12):769–74.

PubMed  Google Scholar 

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.

PubMed  Google Scholar 

Mueller-Wohlfahrt HW, Haensel L, Mithoefer K, Ekstrand J, English B, McNally S, et al. Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med. 2013;47(6):342–50.

PubMed  Google Scholar 

Chan O, Del Buono A, Best TM, Maffulli N. Acute muscle strain injuries: a proposed new classification system. Knee Surg Sports Traumatol Arthrosc. 2012;20(11):2356–62.

PubMed  Google Scholar 

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.

CAS  PubMed  Google Scholar 

Shimozaki K, Nakase J, Asai K, Yoshimizu R, Kimura M, Kanayama T, et al. Relationship between anatomical injury site of rectus femoris muscle strain and time taken to return to play in Japanese professional soccer players. J Orthop Surg (Hong Kong). 2022;30(3):10225536221141786.

PubMed  Google Scholar 

Wangensteen A, Tol JL, Roemer FW, Bahr R, Dijkstra HP, Crema MD, et al. Intra- and interrater reliability of three different MRI grading and classification systems after acute hamstring injuries. Eur J Radiol. 2017;89:182–90.

PubMed  Google Scholar 

Katagiri H, Forster BB, Engebretsen L, An JS, Adachi T, Saida Y, et al. Epidemiology of MRI-detected muscle injury in athletes participating in the Tokyo 2020 Olympic Games. Br J Sports Med. 2022;57(4):218–24.

PubMed  Google Scholar 

Patel A, Chakraverty J, Pollock N, Chakraverty R, Suokas AK, James SL. British athletics muscle injury classification: a reliability study for a new grading system. Clin Radiol. 2015;70(12):1414–20.

CAS  PubMed  Google Scholar 

Fontanier V, Bruchard A, Tremblay M, Mohammed R, da Silva-Oolup S, Suri-Chilana M, et al. Classification of myo-connective tissue injuries for severity grading and return to play prediction: a scoping review. J Sci Med Sport. 2025;28(1):46–55.

PubMed  Google Scholar 

Valle X, Mecho S, Alentorn-Geli E, Jarvinen TAH, Lempainen L, Pruna R, et al. Return to play prediction accuracy of the MLG-R classification system for hamstring injuries in football players: a machine learning approach. Sports Med. 2022;52(9):2271–82.

PubMed  Google Scholar 

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