British medical bulletin最新文献

{"title":"Diagnostic accuracy of clinical examination versus MRI for meniscal tears: a systematic review and meta-analysis.","authors":"Rahul Rana, Navjyot Mehan, Rifat Hassan, Yogeshwar Gohil, Anshika Tyagi, Nicola Maffulli","doi":"10.1093/bmb/ldag023","DOIUrl":"10.1093/bmb/ldag023","url":null,"abstract":"<p><strong>Introduction or background: </strong>Meniscal tears are a common cause of knee morbidity and a frequent indication for arthroscopy. Whether clinical examination, magnetic resonance imaging (MRI), or both should be the first-line diagnostic test remains contested.</p><p><strong>Sources of data: </strong>We searched PubMed, CINAHL Complete, Medline, and Web of Science for paired-design studies in adults in which every patient underwent both composite clinical examination and MRI, with arthroscopy as the reference standard. Ten studies (1643 knees) met our inclusion criteria. Risk of bias was assessed with QUADAS-2; estimates were pooled with a random-effects model.</p><p><strong>Areas of agreement: </strong>For medial meniscal tears, MRI achieved pooled sensitivity of 90% and specificity of 91%; composite clinical examination achieved 85% sensitivity and 95% specificity. For lateral meniscal tears, MRI yielded 81% sensitivity and 82% specificity; composite clinical examination yielded 75% sensitivity and 93% specificity.</p><p><strong>Areas of controversy: </strong>Whether composite clinical examination is interchangeable with MRI as a first-line test; reduced MRI specificity in degenerative meniscal lesions and osteoarthritic knees; and the operator-dependence of clinical examination and the lack of a standardized composite-examination protocol.</p><p><strong>Growing points: </strong>Composite clinical examination by an experienced clinician retains diagnostic value alongside MRI. Paired-design synthesis with arthroscopic verification gives less biased estimates of comparative accuracy than unpaired designs.</p><p><strong>Areas timely for developing research: </strong>Standardization of composite clinical examination protocols; consistent reporting of examiner experience; stratification of MRI accuracy by field strength and pulse sequence; and cost-effectiveness evaluation of clinical-examination-first diagnostic pathways.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulnar variance in youth sport.","authors":"Noah M Scigliano, Ignacio Garcia Fleury, Terry L Hayes, Joseph A Buckwalter V","doi":"10.1093/bmb/ldag030","DOIUrl":"10.1093/bmb/ldag030","url":null,"abstract":"<p><strong>Introduction: </strong>Ulnar variance is a radiographic measurement that describes the relative heights of the distal ulna and radius. Youth athletes who repetitively load their wrist can develop stress injury at the distal radial physis, which may alter longitudinal growth resulting in positive ulnar variance (PUV). This dynamic bony relationship may predilect athletes for wrist pain and/or ulnar-sided pathology; however, the prevalence and clinical significance of ulnar variance in youth athletes is not completely understood.</p><p><strong>Sources of data: </strong>PubMed, CINAHL, EMBASE, and SPORTDiscus were queried in November 2025 without time constraints.</p><p><strong>Areas of agreement: </strong>Ulnar variance is best measured in skeletally immature athletes on posteroanterior radiographs using Hafner's method. Youth athletes exhibit more PUV values on average than non-athlete predicted norms. Its magnitude is not significantly associated with training volume or wrist pain. Positive ulnar variance is a potential end stage of stress injury to the radial growth plate complex. Symptomatic PUV becomes clinically meaningful and may warrant surgical intervention in select cases.</p><p><strong>Areas of controversy: </strong>Reported prevalence of PUV in youth athletes varies widely across studies (0%-50%), reflecting substantial heterogeneity in the existing literature. Inconsistent associations of ulnar variance with multiple anthropometric variables, biological data, and training characteristics prevent clear delineation between the effects of genetics vs repetitive mechanical stress to the distal radial physis on its development. Treatment of symptomatic PUV remains controversial.</p><p><strong>Growing points: </strong>Body composition may uniquely impact ulnar variance magnitude. Distal radial physis stress injury, rather than PUV, may be a primary driver of wrist pain.</p><p><strong>Areas timely for developing research: </strong>Newer prospective investigations incorporating dynamic imaging techniques are warranted to evaluate ulnar variance under physiologic weight-bearing conditions. Future work should include athletes from multiple upper extremity weight-bearing sports (gymnastics, cheerleading, diving, and wrestling) across all levels of participation to better account for the effects of training exposure on ulnar variance. Serial radiographic evaluation may also help define the relationship between progressive PUV and the development of wrist pain and dysfunction.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Boosting early bone healing by freeze-dried bovine leukocyte-platelet rich fibrin and nanohydroxyapatite in rabbit: histopathological, molecular, and Raman spectroscopy analysis.","authors":"Seyed Ali Afzali, Ahmad Oryan, Amin Bigham-Sadegh, Hassan Sharifiyazdi, Amin Safaie, Hamid Nadgaran, Nicola Maffulli","doi":"10.1093/bmb/ldag027","DOIUrl":"10.1093/bmb/ldag027","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, millions suffer from bone fractures every year, with substantial clinical consequences. Intervention is crucial when healing mechanisms are ineffective. Leukocyte-platelet rich fibrin (L-PRF), by its rapid, simple, and cost-effective preparation methodology alongside a calcium phosphate-based compound such as nanohydroxyapatite may favorably impact clinical practice.</p><p><strong>Source of data: </strong>A critical-sized radius bone defect was produced in 25 White New Zealand rabbits divided into five groups (n = 5 per group) including untreated, autograft, nanohydroxyapatite scaffold, bovine lyophilized L-PRF, and nanohydroxyapatite and L-PRF simultaneously. The defects were evaluated 7 days postsurgery by histopathological, molecular, and Raman spectroscopy evaluations.</p><p><strong>Areas of agreement: </strong>Platelet and growth factor content of lyophilized L-PRF powder stimulate cell proliferation and differentiation, and extracellular matrix production. Nanohydroxyapatite scaffold and lyophilized L-PRF powder could effectively enhance early bone regeneration.</p><p><strong>Areas of controversy: </strong>While the autograft group was expected to perform best, as the gold standard of repair, the lyophilized L-PRF group performed best in some indicators of extracellular matrix production, such as matrix-to-mineral ratio and carbonate-to-phosphate ratio.</p><p><strong>Growing points: </strong>Nanohydroxyapatite scaffold played as a mechanical strength provider and had a lesser role in stimulating biological repair responses, in the short term, while L-PRF significantly enhanced cell proliferation and differentiation and extracellular matrix production by releasing osteogenic factors.</p><p><strong>Areas timely for developing research: </strong>The long-term effects of lyophilized L-PRF on bone repair, duration of platelet growth factor release from L-PRF, injecting fresh L-PRF at periodic intervals, and using lyophilized L-PRF alongside other bone-stimulating scaffolds should be addressed in future studies.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Augmentation in Achilles tendon repair: evidence versus enthusiasm.","authors":"Nicola Maffulli, Filippo Migliorini","doi":"10.1093/bmb/ldag019","DOIUrl":"10.1093/bmb/ldag019","url":null,"abstract":"<p><strong>Background: </strong>The routine use of augmentation in the surgical management of primary acute Achilles tendon rupture remains controversial. Biological, mechanical, and synthetic augmentation strategies have been adopted in clinical practice, yet their superiority over standard repair has not been established.</p><p><strong>Sources of data: </strong>A narrative review of peer-reviewed comparative studies, randomized controlled trials, systematic reviews, and meta-analyses retrieved from PubMed and MEDLINE, supplemented by the authors' clinical expertise.</p><p><strong>Areas of agreement: </strong>Standard surgical repair of acute Achilles tendon rupture, whether open or minimally invasive, reliably achieves high patient satisfaction, restoration of function, and acceptable return-to-sport rates. Patient-reported outcome measures and re-rupture rates are consistently comparable between augmented and non-augmented repairs across available randomized and controlled studies.</p><p><strong>Areas of controversy: </strong>Individual studies have occasionally reported statistically significant improvements in surrogate parameters following augmentation, but these rarely exceed minimally clinically important difference thresholds. Complication rates may be higher with augmentation, and endoscopic flexor hallucis longus transfer for acute ruptures has been associated with elevated re-rupture risk.</p><p><strong>Growing points: </strong>Minimally invasive percutaneous repair techniques continue to evolve and provide reliable outcomes without augmentation. The intrinsic regenerative capacity of the Achilles tendon remains the dominant determinant of outcome regardless of operative strategy.</p><p><strong>Areas timely for developing research: </strong>Well-powered randomized controlled trials with patient-centered outcomes are needed to evaluate whether any augmentation strategy offers clinically meaningful benefit in defined subgroups, such as patients with pre-existing tendinopathy, delayed presentation, or large-gap defects.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indirect calculation of metabolic power in soccer: a critical analysis of a popular model.","authors":"Furio Barba, Johnny Padulo, Nicola Maffulli","doi":"10.1093/bmb/ldag022","DOIUrl":"10.1093/bmb/ldag022","url":null,"abstract":"<p><strong>Introduction: </strong>The Global Positioning System (GPS)-based metabolic power model for soccer, proposed by di Prampero and applied by Osgnach, rests on a fixed energy cost (EC) of running of 4.6 J·kg-1·m-1 and a biomechanical equivalence between accelerated level and constant-speed uphill running.</p><p><strong>Sources of data: </strong>A narrative review was conducted via PubMed, Scopus, and Web of Science using terms like metabolic power, EC of running, GPS soccer, sprint biomechanics, equivalent slope, and running economy (2005-2025).</p><p><strong>Areas of agreement: </strong>Running EC is relatively speed-independent across submaximal velocities typical of football (~6-18 km·h-1). The geometric principle underlying the accelerated-to-inclined running equivalence is accepted, and GPS metabolic power provides a useful metric for relative load comparisons.</p><p><strong>Areas of controversy: </strong>A universal fixed EC ignores interindividual variability (~20%), fatigue, surfaces, and drag. The equivalence model has vector orientation inconsistencies, employs the imprecise term 'equivalent mass', and derives its postural reference from sprint-start conditions unrepresentative of match-play accelerations (~2-4 m·s-2). Validation studies show systematic underestimations of 29%-85% relative to indirect calorimetry. Refinements exist but remain unimplemented in most commercial platforms.</p><p><strong>Growing points: </strong>Individually calibrated EC values, inertial measurement unit integration, and hybrid models combining GPS kinematics with cardiorespiratory data are promising. Force-velocity profiling offers a biomechanically grounded alternative for individual sprint characterization.</p><p><strong>Areas timely for developing research: </strong>Priorities include calorimetric validation under match conditions; player-specific EC models incorporating fatigue, surface, and role; implementing model updates in commercial software; and comparing alternative load metrics for injury-risk prediction.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling inflammation and inflammatory diseases in organoids.","authors":"Amber De Moor, Hugo Vankelecom, Kaline Arnauts","doi":"10.1093/bmb/ldag028","DOIUrl":"10.1093/bmb/ldag028","url":null,"abstract":"<p><strong>Introduction: </strong>Organoids are 3D cellular structures that self-establish from stem cells and faithfully recapitulate key features of the tissue of interest. Organoids have emerged as powerful tools for disease modeling by maintaining pathology- and patient-specific characteristics, offering a highly valuable substitute for traditional cellular and animal models that often lack translational accuracy to model complex in vivo disease conditions. Despite its strong power, organoid cultures do not reconstruct the in vivo inflammatory microenvironment and thus do not maintain the imposed inflammatory state, making it challenging to model inflammation-linked diseases.</p><p><strong>Source of data: </strong>PubMed was used as database and source of information.</p><p><strong>Areas of agreement: </strong>Organoids represent powerful tools to unravel disease mechanisms and eventually screen and identify new therapeutic approaches.</p><p><strong>Areas of controversy: </strong>Organoid models represent reliable but still reductionist representations of the in vivo tissue/organ, lacking the complex cell composition. Co-cultures with microenvironmental cell types or nearby impacting signaling factors are required to recapitulate the full disease phenotype, including the inflammatory state of the tissue.</p><p><strong>Growing points: </strong>To obtain more representative inflammatory disease research models, exposure of organoids to inflammatory stimuli such as cytokines and co-cultures with immune cells or microbiota are being established.</p><p><strong>Areas timely for developing research: </strong>Implementation of advanced cellular complexity and inflammation in organoid models will enable the study of inflammatory disease-driving mechanisms in an accurate and relevant setting, and result in advanced clinical translation of research findings.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and therapeutic dilemmas in chronic exertional compartment syndrome.","authors":"Sanne Vogels, Wes O Zimmermann","doi":"10.1093/bmb/ldag020","DOIUrl":"10.1093/bmb/ldag020","url":null,"abstract":"<p><strong>Background: </strong>Exercise-induced leg pain is a common and often disabling complaint in young and physically active individuals. Chronic exertional compartment syndrome (CECS) remains one of the most debated diagnoses within this spectrum due to persistent uncertainty regarding its pathophysiology, diagnostic criteria, and treatment strategies.</p><p><strong>Sources of data: </strong>This review draws on the authors' previous systematic reviews, original cohort studies, international consensus work, and updated PubMed-indexed literature on diagnostic approaches, intracompartmental pressure (ICP) measurement, and treatment outcomes.</p><p><strong>Areas of agreement: </strong>CECS presents with a characteristic pattern of exertional pain and tightness that resolves with rest. Clinical history remains central, supported by a positive symptom provocation test. Conservative management, particularly structured rehabilitation with activity modification and gait retraining, is increasingly considered first-line therapy. Surgical decompression is effective in patients with persistent, typical symptoms who fail conservative treatment and opt for surgical management.</p><p><strong>Areas of controversy: </strong>The diagnostic value of ICP measurement remains highly debated. Common thresholds lack robust validation and show limited sensitivity and specificity, with considerable methodological variability. Additional controversies include heterogeneity in surgical techniques, postoperative care, and the absence of clear criteria for surgical timing.</p><p><strong>Growing points: </strong>Emerging research focuses on alternative diagnostic strategies, including non-invasive imaging, dynamic functional testing, and symptom-based clinical algorithms.</p><p><strong>Areas timely for developing research: </strong>Future research should address the central question of symptom aetiology. CECS has traditionally been viewed as a perfusion-related disorder, yet this remains unproven. Improved understanding of underlying mechanisms is essential, alongside with refinement of conservative treatment, patient selection for surgery, and development of validated diagnostic pathways and outcome measures.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional musculoskeletal pain in workers-is the traditional medical model increasing disability?","authors":"Karen Walker-Bone, Rachelle Buchbinder","doi":"10.1093/bmb/ldag017","DOIUrl":"10.1093/bmb/ldag017","url":null,"abstract":"<p><strong>Introduction: </strong>Musculoskeletal disorders frequently cause work disability. For low back pain, a de-medicalized approach is advocated, whereas a biomedical approach is taken for shoulder and elbow/forearm pain.</p><p><strong>Sources of data: </strong>PubMed, Cochrane Library, Google Scholar.</p><p><strong>Areas of agreement: </strong>Guidelines for the management of low back pain recommend de-medicalization, rapid mobilization, avoidance of imaging, second-line use of pharmacological treatments, and an emphasis on self-management and remaining in or rapidly returning to work.</p><p><strong>Areas of controversy: </strong>Despite evidence for many treatment modalities, shoulder pain and elbow/forearm pain are still managed using a biomedical model that separates conditions into distinct diseases and treats them accordingly.</p><p><strong>Growing points: </strong>Should pain at the shoulder and elbow/forearm be de-medicalized, with greater emphasis on maintaining mobility and work participation?</p><p><strong>Areas timely for developing research: </strong>Testing integrated occupational and health interventions for musculoskeletal disorders, focusing on their effectiveness in work rehabilitation and reducing disability.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-inflammatory and tissue-healing effects of semiconductor-embedded fabrics: current evidence and future perspectives.","authors":"Erwin Pavel Lamparelli, Saveria Batti, Claudia Orlanno, Federica Montella, Gina Myers, Nicola Maffulli, Giovanna Della Porta","doi":"10.1093/bmb/ldag024","DOIUrl":"10.1093/bmb/ldag024","url":null,"abstract":"<p><strong>Background: </strong>Wearable fabrics embedding crystalline semiconductor materials (e.g. germanium, silicon) are promising biomedical devices for their therapeutic potential in musculoskeletal disorders, including osteoarthritis, tendinopathies, and chronic pain, and for supporting tissue healing and regeneration. These fabrics exert their bioactive functions without applying mechanical pressure or drug delivery systems, offering a non-invasive and comfortable therapeutic alternative that operates through mild thermal stimuli at body temperature.</p><p><strong>Sources of data: </strong>Recent peer-reviewed literature on semiconductor-based wearable textiles, far-infrared-emitting biomaterials, bioelectric signalling in tissue repair, and their clinical application in musculoskeletal disorders.</p><p><strong>Areas of agreement: </strong>At body temperature, semiconductor-containing fabrics consistently emit far-infrared radiation, experimentally associated with improved microcirculation and modulation of inflammation. Limited clinical studies report improvements in pain and functional outcomes in chronic musculoskeletal conditions, with good tolerability during prolonged wear.</p><p><strong>Areas of controversy: </strong>Proposed mechanisms include thermally induced electron release, ion generation, and piezoelectric or piezoresistive activity during movement, but direct biological evidence remains limited. The specific contribution of far-infrared emission is difficult to distinguish from thermal or placebo effects.</p><p><strong>Growing points: </strong>Advances in bioelectric signalling research and textile engineering provide a framework to investigate electroactive interactions between semiconductor fabrics and biological tissues.</p><p><strong>Areas timely for developing research: </strong>Well-designed randomized trials, quantitative characterization of emitted physical stimuli, and mechanistic cellular studies are needed to establish clinical efficacy and inform regulatory classification.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triceps surae muscle injuries-a clinical challenge more complex than you think.","authors":"Ramon Balius, Carles Pedret, Montse Pujol-Marzo, Xavier Valle, Javier de la Fuente","doi":"10.1093/bmb/ldag021","DOIUrl":"10.1093/bmb/ldag021","url":null,"abstract":"<p><strong>Introduction: </strong>Calf muscle injuries are common in running and sprint-based sports, but remain too often grouped under a single label despite important differences between gastrocnemius, soleus and, less commonly, plantaris-related injuries. This review evaluates current evidence on anatomy, diagnosis, imaging, classification, prognosis, return to play, and recurrence.</p><p><strong>Sources of data: </strong>A structured narrative review was undertaken using PubMed/MEDLINE and Scopus, with searches updated to 23 February 2026. After deduplication and screening, 82 articles were included, including eight seminal pre-window studies.</p><p><strong>Areas of agreement: </strong>Calf injuries generate substantial time-loss and recurrence burden. Age and previous calf injury are the most consistent risk factors. The soleus has been underdiagnosed, while imaging is most useful when it clarifies anatomy and tissue involvement rather than replacing clinical judgement. Connective tissue disruption, particularly involving aponeurosis or intramuscular tendon, appears more prognostically relevant than oedema alone.</p><p><strong>Areas of controversy: </strong>General muscle injury classifications improve terminology but incompletely capture the complexity of distal calf injuries. The precise prognostic value of MRI findings, isolated anatomical location and serial imaging remains uncertain, and return-to-play endpoints are inconsistently defined across studies.</p><p><strong>Growing points: </strong>The field is moving from oedema-based grading towards tissue-based, muscle-specific classification, especially for soleus and distal medial gastrocnemius injuries. Rehabilitation is increasingly understood as progressive re-exposure to running, elastic loading, and sport-specific demands rather than symptom resolution.</p><p><strong>Areas timely for developing research: </strong>Priorities include harmonized definitions of recurrence and return to play, integrated prognostic models combining clinical, imaging and load data, and comparative trials of calf-specific rehabilitation.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}