Proposed Modified Classification System of the Munich Consensus Statement. Can the Area of Hemorrhagic Effusion in Muscle Injuries Be the Dividing Line between Mild (3A) and Moderate (3B) Injuries?

Purpose or Learning Objective: Muscle injuries are common in competitive sports. Magnetic resonance imaging and ultrasound are the most often used methods to evaluate muscle injuries. Several classification systems for muscle injuries have been published. Mueller-Wohlfahrt et al introduced a new one in 2013, currently the most widely used, with grading to reflect comprehensively the diverse spectrum of muscle injuries observed in athletes. The differentiation between lesions classified as type 3A (minor partial muscle tear) and 3B (moderate partial muscle tear) remains to be more precisely defined. In relation to recovery time, we researched possible statistically significant differences.

Methods or Background: We conducted a comprehensive analysis of 100 magnetic resonance imaging studies performed on high-level professional athletes who exhibited clinical signs of lower limb muscle injuries. We selected individuals whose myotendinous or myofascial lesions could be labeled as 3A or 3B according to the Mueller-Wohlfarth classification. The athletes were then categorized into groups based on the presence or absence of fluid collection at the site of injury. The study's medical practitioner provided data regarding the duration of the injury and the actual return to sporting activities. A linear regression test was conducted to examine the correlation between the variable fluid collections and the duration of the injury. Then the Fisher t test or Mann-Whitney test was applied.

Results or Findings: The results of the association between “blood collection” and “duration of injury” revealed a statistically significant correlation. The median value of return to play in patients with a hemorrhagic collection (median: 29) is significantly higher compared with patients without a hemorrhagic collection (median: 19), with a difference between the two samples of 10 days.

Conclusion: Our study highlights how this distinction could be easily practiced by recognizing the presence of a hemorrhagic collection and how it predominates in determining a worsening of the prognosis and therefore an extension of the return to play. We can conclude that athletes who do not have a blood collection but only interstitial hemorrhage between fibers can be considered type 3A, whereas athletes with interstitial hemorrhage at diagnosis can be labeled as type 3B.

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Artikel online veröffentlicht:
02. Juni 2025