Magnetic resonance classification proposal for medial gastrocnemius muscle injuries

Calf muscle injuries are common among athletes and occupational populations, with highly variable recovery times that are challenging to be predicted at the initial clinical evaluation. Specifically, in distal gastrocnemius muscle injuries, an ultrasound-based severity classification has shown to be useful for estimating the recovery time. According to the location of lesions and the recognition of some US signs, four types of injuries of the distal gastrocnemius muscle were described. Since magnetic resonance imaging (MRI) has proven to be useful in diagnosing and prognosticating muscle injuries by assessing the extent of affected connective tissue, a specific MRI protocol involving T1-weighted and fluid-sensitive static and dynamic acquisitions has been developed aimed to characterize the four types of injuries. We here describe the characteristics of this new MRI protocol and the interpretation of images, which will be useful to improve the recognition of acute and delayed distal gastrocnemius muscle injuries. The proposed classification includes: myoaponeurotic muscle injury without aponeurotic discontinuities (type 1), myoaponeurotic muscle injury with aponeurotic discontinuities (type 2), isolated free aponeurosis discontinuity (type 3), and a mixed myoaponeurotic-aponeurotic injury pattern (type 4). A comprehensive understanding of the MRI features associated with each injury type, in conjunction with multidisciplinary team collaboration, is essential for optimizing the athlete's recovery and return to play.