E1101. MRI-depicted Muscle Injuries in Athletes Participating in the Rio de Janeiro 2016 Summer Paralympics
  1. Daichi Hayashi; Boston University School of Medicine; Stony Brook Medicine
  2. Michel Crema; Boston University School of Medicine; French National Institute of Sports
  3. Mohamed Jarraya; Massachusetts General Hospital
  4. Cheri Blauwet; Spaulding Rehabilitation Hospital and Brigham and Women's Hospital
  5. Frank Roemer; Boston University School of Medicine; Friedrich-Alexander University Erlangen-Nuremberg
  6. Wayne Derman; IOC Research Center; Stellenbosch University
  7. Guermazi Ali; Boston University School of Medicine; VA Healthcare System
To describe the frequencies, the anatomic distribution, and the severity of MRI-depicted muscle injuries involving para athletes during the Rio de Janeiro 2016 Summer Paralympic Games. To compare and contrast differences in imaging-depicted muscle injury patterns between those participating in Olympic and Paralympic Games, and how underlying impairment might have contributed to a specific injury pattern unique to Paralympians.

Materials and Methods:
MRI-depicted muscle injuries were identified upon retrospective review of all MRI studies in Paralympic athletes during the Games of 2016 Summer Paralympic in Rio de Janeiro. MRI examinations were performed at the International Paralympic Committee (IPC)’s polyclinic within the Games Village, using 3.0T and 1.5T MRI scanners. Images were independently and centrally evaluated retrospectively by five board-certified musculoskeletal radiologists with expertise in sports injuries. We recorded the distribution of imaging-depicted muscle injuries by sports discipline, athletes’ impairment type, anatomic location and the severity of injuries using the modified Peetrons classification [1] and the British Athletics Muscle Injury Classification (BAMIC) [2]. Detailed demographic characteristics including impairment type [3] were also analyzed.

In total, 4378 para athletes from 160 teams were included. A total of 242 MRI exams were performed. Of these, centralized review of MRI revealed 35 muscle injuries in 33 athletes (73% male, mean age: 28.7 years - range 20-41). 17 para athletes had visual impairment, which was the most common impairment type followed by physical impairment due to upper limb deficiency (N=6, 18%). Para athletes from athletics disciplines were most commonly affected by muscle injuries (N=23, 66%), followed by football players (N=4, 11%) and powerlifters (N=4, 11%). The majority of injuries affected muscles of the lower limbs (N=28, 80%), with the biceps femoris being the most commonly involved muscle (N=10, 29%). Most frequent injuries were grade 1 injuries according to the modified Peetrons classification (N=15, 43%) and grade 2a injuries according to BAMIC classification (N=7, 20%).

MRI-depicted muscle injuries in this population were rare (up to 2%). Hamstring muscle injuries were the most common and were observed most frequently in para athletes competing in athletics. Characteristic injury patterns were noted for para athletes with certain categories of impairment. For example, lower limb muscle injuries only were seen in athletes with limb deficiencies (either upper or lower). Conversely, upper limb muscle injuries only were found in powerlifters. Almost half of all athletes had visual impairment and this category of athletes had variety of upper and lower limb muscle injuries overall. These injury patterns were also seen in broader para athlete injury epidemiological studies [4]. For ambulatory athletes, muscle injury patterns were comparable to those reported for Summer 2016 Olympic athletes [5].