Sports activity resumption after lower-limb muscle and tendon injuries in athletes: The role of shear-wave elastography in diagnosis and healing assessment: A narrative review

Abstract

Background: Muscle and tendon injuries of the lower limb are common in athletes and often require prolonged rehabilitation before returning to sport. Shear-wave elastography (SWE) enables quantitative assessment of tissue mechanical properties and may provide information beyond conventional morphological imaging.
Aim: Sports activity resumption after lower-limb muscle and tendon injuries is a key focus of this narrative review, which summarizes current evidence on SWE in diagnosis, monitoring of healing and rehabilitation, and assessment of readiness to return to sport.
Material and methods: Studies evaluating SWE in lower-limb muscle and tendon injuries were reviewed.
Results: Studies demonstrate measurable SWE changes in hamstring and calf muscle injuries, Achilles tendon pathology and rupture, and patellar tendinopathy. However, the direction and magnitude of stiffness changes vary according to tissue type, injury stage, loading conditions, training status, acquisition protocol, and ultrasound system. Serial SWE measurements may therefore be more informative than isolated absolute values, particularly when performed under standardized conditions and interpreted alongside clinical and functional recovery.
Conclusions: At present, SWE should be considered a complementary tool rather than a stand-alone diagnostic or return-to-sport criterion. Universal reference ranges and validated cutoff values are lacking, and the relationship between SWE normalization, re-injury risk, and readiness to return to sport remains uncertain. Further prospective studies using standardized protocols and clinically relevant outcomes are needed.