Abstract
To address the issues of subjectivity, low efficiency, and missed diagnoses of subtle injuries in magnetic resonance imaging (MRI) diagnosis of knee injuries after skiing in adolescents, a precise automatic diagnostic model was constructed to achieve simultaneous segmentation and classification of different types of injuries. A hybrid model combining U-Net + + and DenseNet121 was employed. U-Net + + performed pixel-level segmentation of injured areas, while DenseNet121 classified the injuries based on fused features. The model was trained using a dataset of 309 adolescent MRI scans through a joint loss function and transfer learning strategy. In the segmentation task, the average Dice coefficient (DC) was 0.89, and the intersection over union (IoU) was 0.82. The highest accuracy was achieved for meniscus tears (0.93, 0.87) and anterior cruciate ligament injuries (0.89, 0.82). Cartilage injuries (0.84, 0.77) showed a 6.4% improvement compared to the original U-Net. In the classification task, the average accuracy was 0.90, the F1-score was 0.91, and the area under the ROC curve (AUC) was 0.95. The recall rate for meniscus tears was 0.93, with a precision of 0.94, and the recall rate for cartilage injuries was 0.87. These results were significantly higher than those of SVM + handcrafted features (F1 = 0.77) and ResNet50 (F1 = 0.85) (P < 0.01). The model can efficiently and accurately perform automatic diagnosis of multiple injury types on MRI scans, outperforming traditional methods. It reduces the rate of missed and incorrect diagnoses, improves diagnostic consistency and efficiency, and holds value for clinical auxiliary applications.
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author Songmei Li on reasonable request via e-mail htxiayuxue2000@126.com.
References
Veldman, H. D., Jeuken, R. M., Voskuilen, R. N. & Verlaan, L. Operatively treated ischial tuberosity avulsion in an adolescent snowboarder: treatment, patient’s perspective, and critical appraisal of current literature on the indication for surgery. BMJ Case Rep. ;18(6): e264107. (2025). https://doi.org/10.1136/bcr-2024-264107. PMID: 40588300.
Hanimann, J. et al. Jump performance and movement quality in 7- to 15-year-old competitive alpine skiers: a cross-sectional study. Ann. Med. 56 (1), 2361254 (2024). Epub 2024 Jun 4. PMID: 38833367; PMCID: PMC11151804.
Liu, R. K. K. et al. Comparing Single-Site Fractures with Multisite Injuries in Pediatric Skiers and Snowboarders. Wilderness Environ Med. ;36(4):542–548. doi: 10.1177/10806032251345771. Epub 2025 Jun 11. PMID: 40495671. (2025).
Mugniery, Q., Ricard, C., Mirtain, S., Navarre, M. & Tanné, C. Epidemiology of paediatric winter sports-related injuries in France: The WINTRAUMA-1 retrospective cohort study. Acta Paediatr. 114 (3), 603–610. https://doi.org/10.1111/apa.17480 (2025). Epub 2024 Nov 1. PMID: 39487605; PMCID: PMC11828721.
Liao, J. & Yu, K. MRI Radiomics-Based Diagnosis of Knee Meniscal Injury. J. Comput. Assist. Tomogr 2025 Nov-Dec 01;49(6):952–957. https://doi.org/10.1097/RCT.0000000000001759. Epub 2025 Apr 14. PMID: 40249263.
Jing, Z. et al. MRI measurement analysis of risk factors for popliteal artery injury in knee surgery. J. Orthop. Surg. (Hong Kong). 33 (2), 10225536251330659 (2025). Epub 2025 May 6. PMID: 40326003.
Wang, Y. et al. Multitask learning for automatic detection of meniscal injury on 3D knee MRI. J. Orthop. Res. 43 (3), 703–713. https://doi.org/10.1002/jor.26024 (2025). Epub 2024 Dec 2. PMID: 39620311.
Zhang, S., Zheng, T., Jin, J., Ye, C. & He, R. Diagnostic Value of Pericruciate Fat Pad Measurement by MRI in Patients With Knee Articular Cartilage Injury. Br. J. Hosp. Med. (Lond). 86 (4), 1–13 (2025). 2024.0824. Epub 2025 Apr 15. PMID: 40265547.
Donners, R. et al. Deep Learning Reconstructed New-Generation 0.55 T MRI of the Knee: A Prospective Comparison With Conventional 3 T MRI. Invest Radiol. ;59(12):823–830. (2024). https://doi.org/10.1097/RLI.0000000000001093. Epub 2024 Jun 11. PMID: 38857414.
Foti, G. et al. Deep learning-driven abbreviated knee MRI protocols: diagnostic accuracy in clinical practice. Radiol Med. ;130(9):1460–1471. (2025). https://doi.org/10.1007/s11547-025-02038-3. Epub 2025 Jul 4. PMID: 40613973.
Botnari, A., Kadar, M., Puia, D. R. & Patrascu, J. M. Jr Automated Segmentation of Knee Menisci Using U-Net Deep Learning Model: Preliminary Results. Maedica (Bucur). 19 (4), 690–695. https://doi.org/10.26574/maedica.2024.19.4.690 (2024). PMID: 39974461; PMCID: PMC11834842.
Botnari, A., Kadar, M., Patrascu, J. M. & Considerations on Image Preprocessing Techniques Required by Deep Learning Models. The Case of the Knee MRIs. Maedica (Bucur). 19 (3), 526–535. https://doi.org/10.26574/maedica.2024.19.3.526 (2024). PMID: 39553362; PMCID: PMC11565144.
Roy, C. et al. MRI detection and grading of knee osteoarthritis - a pilot study using an AI technique with a novel imaging-based scoring system. Biomater Sci. ;13(19):5475–5494. (2025). https://doi.org/10.1039/d5bm00470e. PMID: 40889152.
Yasin, P. et al. Dual-center study on AI-driven multi-label deep learning for X-ray screening of knee abnormalities. Sci. Rep. 15 (1), 38014. https://doi.org/10.1038/s41598-025-21895-6 (2025). PMID: 41168262; PMCID: PMC12575809.
Hanimann, J. et al. Traumatic knee injuries and career drop-outs in adolescent competitive alpine skiers aged 15–19: a longitudinal 4-year follow-up study examining rates, biomechanical injury risk factors and potential reasons for quitting. Ann. Med. 57 (1), 2532118 (2025). Epub 2025 Jul 15. PMID: 40662700; PMCID: PMC12265098.
Kastner, T. et al. Injuries and illnesses during the 54th FIS Nordic World Ski Championships 2023 in Planica: a prospective cohort study. BMJ Open. Sport Exerc. Med. 11 (2), e002156. https://doi.org/10.1136/bmjsem-2024-002156 (2025). PMID: 40226334; PMCID: PMC11987098.
Mead, K. et al. MRI deep learning models for assisted diagnosis of knee pathologies: a systematic review. Eur. Radiol. 35 (5), 2457–2469. https://doi.org/10.1007/s00330-024-11105-8 (2025). Epub 2024 Oct 18. PMID: 39422725; PMCID: PMC12021734.
Sun, J., Cao, Y., Zhou, Y. & Qi, B. Leveraging spatial dependencies and multi-scale features for automated knee injury detection on MRI diagnosis. Front. Bioeng. Biotechnol. 13, 1590962. https://doi.org/10.3389/fbioe.2025.1590962 (2025). PMID: 40395675; PMCID: PMC12088959.
Cerezal, A., Roriz, D., Canga, A. & Cerezal, L. Imaging of sports injuries in adolescents. Pediatr. Radiol. 55 (4), 644–659. https://doi.org/10.1007/s00247-024-05991-9 (2025). Epub 2024 Jul 12. PMID: 38995428.
Gicquel, P. Knee ligament and meniscus injuries in children and teenagers. Orthop. Traumatol. Surg. Res. 111 (1S), 104073. https://doi.org/10.1016/j.otsr.2024.104073 (2025). Epub 2024 Nov 26. PMID: 39608639.
Pan, J. et al. Automatic knee osteoarthritis severity grading based on X-ray images using a hierarchical classification method. Arthritis Res. Ther. 26 (1), 203. https://doi.org/10.1186/s13075-024-03416-4 (2024). PMID: 39558425; PMCID: PMC11571664.
Zhou, L., Nguyen, T., Choi, S. & Yoon, J. U-Net-Based Deep Learning Hybrid Model: Research and Evaluation for Precise Prediction of Spinal Bone Density on Abdominal Radiographs. Bioeng. (Basel). 12 (4), 385. https://doi.org/10.3390/bioengineering12040385 (2025). PMID: 40281745; PMCID: PMC12025265.
Lyu, Y. & Tian, X. MWG-UNet++: Hybrid Transformer U-Net Model for Brain Tumor Segmentation in MRI Scans. Bioeng. (Basel). 12 (2), 140. https://doi.org/10.3390/bioengineering12020140 (2025). PMID: 40001660; PMCID: PMC11852190.
Wang, Y. et al. Diffusion-CSPAM U-Net: A U-Net model integrated with a hybrid attention mechanism and diffusion model for segmentation of computed tomography images of brain metastases. Radiat. Oncol. 20 (1), 50. https://doi.org/10.1186/s13014-025-02622-x (2025). PMID: 40188354; PMCID: PMC11971865.
Pujol, N. et al. The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part I-Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction). Knee Surg. Sports Traumatol. Arthrosc. 33 (8), 3002–3013. https://doi.org/10.1002/ksa.12674 (2025). Epub 2025 May 12. PMID: 40353298; PMCID: PMC12310086.
Toyono, S. et al. Predicting anterior cruciate ligament degeneration using magnetic resonance imaging: Insights from histological evaluation. J. Orthop. Sci. 30 (2), 325–332 (2025). Epub 2024 May 21. PMID: 38772763.
Mercurio, M. et al. Deep Learning Models to Detect Anterior Cruciate Ligament Injury on MRI: A Comprehensive Review. Diagnostics (Basel). 15 (6), 776. https://doi.org/10.3390/diagnostics15060776 (2025). PMID: 40150118; PMCID: PMC11941175.
van Zandee, E. D., Fritz, R. C., Chaudhari, A. S. & Boutin, R. D. Cartilage Imaging: MRI of Chondral Degeneration and Injury. Clin. Sports Med. 44 (3), 467–498 (2025). Epub 2024 Oct 4. PMID: 40514150.
Miller, E. Y. et al. MRI-derived articular cartilage strains predict patient-reported outcomes six months post-anterior cruciate ligament reconstruction. Sci. Rep. 15 (1), 21426. https://doi.org/10.1038/s41598-025-05306-4 (2025). PMID: 40594341; PMCID: PMC12214938.
Wang, R., Kou, Q. & Dou, L. LIT-Unet: a lightweight and effective model for medical image segmentation. Radiol. Phys. Technol. 17 (4), 878–887. https://doi.org/10.1007/s12194-024-00844-4 (2024). Epub 2024 Sep 20. PMID: 39302610.
Garbaz, A. et al. MLFA-UNet: A multi-level feature assembly UNet for medical image segmentation. Methods 232, 52–64. https://doi.org/10.1016/j.ymeth.2024.10.010 (2024). Epub 2024 Oct 29. PMID: 39481818.
Funding
Research on the Logical Rationale and Practical Pathways of New Quality Productive Forces Empowering the High-Quality Development of the Ice and Snow Sports Industry (Project No. 25156), a Key Research Project on Economy and Society of Heilongjiang Province for 2025.
Author information
Authors and Affiliations
Contributions
Wei Xu:Conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, writing—original draft preparationSongmei Li:writing—review and editing, visualization, supervision, project administration, funding acquisitionGuofeng Zhang:methodology, software, validation, formal analysisQi Zhang:formal analysis, investigation, resources, data curationWeidong Song: visualization, supervision, project administration.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics statement
The study was conducted in accordance with the Declaration of Helsinki, the studies involving human participants were reviewed and approved by Graduate School, Harbin Sport University Ethics Committee (Approval Number: 2023.1200232). The participants provided their written informed consent to participate in this study. All methods were performed in accordance with relevant guidelines and regulations.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Xu, W., Li, S., Zhang, G. et al. Magnetic resonance imaging diagnosis of knee injuries after skiing in adolescents under deep learning. Sci Rep (2026). https://doi.org/10.1038/s41598-026-47058-9
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-47058-9