Sonographic Evaluation of Acute Musculotendinous Injuries Among Professional Football Players in the Iraqi Premier League: A Retrospective Study

Background: Acute musculotendinous injuries represent a substantial clinical and economic burden in professional football, leading to significant time loss and performance impairment. Objective: To comprehensively evaluate the anatomical distribution and grading of acute musculotendinous injuries among professional Iraqi League players using ultrasound and to analyze associations between injury patterns, playing positions, and sonographic findings. Methods: A cross-sectional study was conducted at the Private Radiology Clinic in Baghdad between January 2022 and January 2025. It initially included 92 professional male football players who complained of acute onset of muscle pain during an official match or training session and sustained acute musculotendinous injuries and underwent ultrasound examination within 72 hours of injury. Results: The most common site of injury is the hamstring muscle (47.8%); Grade 2 injuries were the most prevalent. There was a perfect agreement between the two radiologists, and this agreement was statistically significant (kappa=0.846, p=0.001). Older players, the striker position, and injuries during matches rather than during training emerged as key factors increasing the possibility of more severe injuries. The highest prevalence of hamstring muscle injuries was seen significantly among strikers and winger players (66.7%, p=0.001), while all goalkeepers suffered from adductor muscle injuries (100%). Conclusions: The study validates musculoskeletal ultrasonography as a rapid, cost-effective, and reliable technique for diagnosing and categorizing muscle injuries in a competitive sports environment. It further backs the use of pitch-side ultrasound to quickly and accurately detect injuries, which can help with important decisions about returning to play.