Diagnostic Imaging Modalities in Acute Sports Injuries - A Comprehensive Review of Clinical Efficacy and Diagnostic Algorith

Abstract

Acute sports injuries impose a substantial diagnostic burden on emergency departments, primary care sports medicine clinics, and team physicians, where the accuracy and timeliness of imaging directly influence treatment planning and return-to-play decisions. This narrative review synthesizes current evidence on the diagnostic performance of conventional radiography, ultrasound, magnetic resonance imaging, and computed tomography in the setting of acute musculoskeletal trauma sustained during athletic activity. Comparative sensitivity and specificity data are presented for common injury patterns, including ankle and knee ligamentous injury, meniscal tears, acute muscle strains, occult fractures, and shoulder instability. Building on validated clinical decision rules, appropriateness criteria, and quality-improvement models, the review proposes an integrated, stepwise diagnostic algorithm, termed PRISM (Prioritized Radiologic Imaging in Sports Medicine), intended to guide modality selection according to injury mechanism, anatomical region, and resource availability. The review concludes that a structured, evidence-based imaging pathway reduces unnecessary advanced imaging, shortens time to definitive diagnosis, and supports safer, more consistent return-to-play decision-making across amateur and professional sporting contexts.