Imaging Pathways in Lower-Limb Muscle Lesions and Their Role in Return-to-Training and Return-to-Play Decision-Making

Lower-limb muscle injuries represent a significant burden in sports medicine, commonly prompting acute imaging in athletes presenting with pain, dysfunction, or suspected trauma. These injuries vary from classic muscle strains and contusions involving the hamstrings, quadriceps, adductors, and calves, to more complex presentations such as myo-aponeurotic, intratendinous, and avulsion-type lesions. Reliable imaging is pivotal in early detection, severity assessment, and management decisions, especially in emergency and urgent-care settings where prompt and accurate diagnosis influences return-to-play timelines and long-term outcomes. Although imaging using MRI and ultrasound has advanced significantly, real-world challenges remain inconsistent protocols, varied classification systems, and reporting discrepancies all contribute to difficulties in comparing outcomes across institutions or standardizing patient care.Recent years have witnessed a paradigm shift toward more reproducible, structured classification and reporting systems in muscle lesion imaging. Studies have underscored the value of precise anatomical characterization, particularly regarding aponeurotic and intratendinous involvement, to predict prognosis and inform clinical interventions. Furthermore, emerging quantitative imaging techniques, the integration of artificial intelligence algorithms, and consensus-driven terminologies have been shown to enhance lesion detection, severity grading, and outcome prediction. However, despite these promising advances, substantial variability persists in imaging pathways, reporting practices, and outcome metrics, underscoring the necessity for consensus and further validation in both research and clinical settings.This Research Topic aims to advance the field by promoting standardized, clinically actionable imaging practices for acute lower-limb sports muscle lesions. We seek research that bridges the gap between radiologic findings and patient outcomes, enhances diagnostic accuracy, fosters effective interdisciplinary communication, and develops structured frameworks for reporting and prognosis. Key objectives include evaluating what should be imaged, when and how imaging should be performed and interpreted, and how to report results to optimize safe, timely return-to-sport decisions while minimizing missed diagnoses and complications.The scope of this Research Topic is limited to acute lower-limb muscle injuries in sports, focusing on real-world imaging protocols, actionable classification, and their impact on clinical decision-making and outcome prediction.To gather further insights in this area, we welcome articles addressing, but not limited to, the following themes:- Emergency and urgent-care imaging pathways for acute lower-limb muscle injuries in sport- Ultrasound technique, timing, dynamic assessment, and structured reporting for muscle lesions- MRI protocols and optimized sequences for lesion anatomy, extent, and tendon/aponeurosis involvement- Classification systems, grading reproducibility, and inter-reader agreement studies- Imaging predictors of return-to-training/return-to-play and reinjury risk (prognostic imaging)- Differential diagnosis and acute complications (large hematoma, avulsion, compartment syndrome, mimics)- Follow-up imaging and healing: interpreting residual edema, fibrosis, and suspicion of re-injury- Quantitative imaging biomarkers (including elastography where relevant) and clinical validation- AI and radiomics: automated segmentation, prediction models, external validation, generalizability- Sport-, sex-, age-, and performance-level differences in injury patterns and imaging needs.We welcome high-quality, within-scope submissions of all article types, including FAIR² Data submissions, which enable publication of your datasets as peer-reviewed, citable resources optimized for reuse and AI-driven analysis. Learn more about FAIR² Data Management here. Together, these contributions will strengthen evidence for standardized, clinically actionable imaging and reporting of acute lower-limb sports muscle injuries and accelerate progress in research and patient care. Topic editors: FRANCESCO ARRIGONI, Raffaele Natella, Marcello Zappia Source: https://www.frontiersin.org/research-topics/78623/imaging-pathways-in-lower-limb-muscle-lesions-and-their-role-in-return-to-training-and-return-to-play-decision-making