Abstract Background Muscle herniae are an uncommon distinct clinical entity within the broad spectrum of exercise-induced leg pain (EILP). Given the symptomatic overlap with other prevalent conditions and physicians’ lack of familiarity, muscle herniae are frequently misdiagnosed, leading to ineffective therapeutic strategies. Sources of data We conducted a comprehensive review of the literature to analyze the pathophysiological mechanisms, diagnostic pitfalls, and therapeutic paradigms associated with muscle herniation in athletes. Areas of agreement Standard static magnetic resonance imaging yields a high rate of false negatives. Dynamic ultrasonography is the diagnostic gold standard, allowing for real-time visualization of the fascial defect under load. Areas of controversy A ‘surgical paradox’ exists regarding surgical management: direct repair (closure) of the fascial defect increases intracompartmental pressure and risks to precipitate acute compartment syndrome, whereas surgeons historically debated the morbidity of open decompression. Growing points Decompression fasciotomy, especially minimally invasive fasciotomy, have emerged as the safest and most effective solution for symptomatic patients, prioritizing functional decompression over anatomical restoration. Areas timely for developing research Current guidelines rely predominantly on Level IV-V evidence. Future prospective comparative studies are needed to further standardize surgical indications and long-term outcomes.
Antonetti et al. (Sat,) studied this question.