Avulsion Injuries and Ruptures of the Proximal Rectus Femoris in Skeletally Mature, High-Level Athletes

Abstract

Injuries to the proximal rectus femoris remain rare, occurring primarily in soccer and American football athletes during kicking and sprinting because of its unique biarthrodial nature.The appropriate diagnosis is dependent on careful physical examination and imaging interpretation.While no universal treatment algorithm has been adopted for high-level athletes, recent investigations support operative repair using suture anchors to restore strength and function in order to allow an effective return to competition while minimizing the risk of injury recurrence.Complications following surgical management include injury to the lateral femoral cutaneous nerve and hematoma formation, and there are reports of residual pain and weakness with chronic injuries that fail the initial nonoperative treatment.Current investigations examining outcomes following treatment remain limited, warranting additional studies that examine patient-reported results, return-to-play rates, and the role of orthobiologics and accelerated rehabilitation protocols following injury to further improve athlete health and safety.

Biomechanical Comparison Between Double-Row Repair and Soft Tissue Tenodesis for Treatment of Proximal Rectus Femoris Avulsions

“…However, the prevalence of PRF injuries is 0.5% to 1.5% of hip injuries that occur in athletes. 17 As the prevalence of reported PRF injuries is low, PRF injuries are often overlooked and undertreated, leading to chronic injuries with sustained symptoms and additional time lost from sports for the athletes. 9,1,6 Traditionally, PRF injuries in high-level athletes have been treated nonoperatively, utilizing a combination of stretching, ice, manual therapies, and gradual strengthening, with multiple studies reporting favorable clinical outcomes.…”

“…However, the prevalence of PRF injuries is 0.5% to 1.5% of hip injuries that occur in athletes. 17 As the prevalence of reported PRF injuries is low, PRF injuries are often overlooked and undertreated, leading to chronic injuries with sustained symptoms and additional time lost from sports for the athletes. 9 , 1 , 6 …”

Isolated, Full-Thickness Proximal Rectus Femoris Injury in Competitive Athletes: A Systematic Review of Injury Characteristics and Return to Play

“…7,8,28 In nonkicking athletes, sprinting is a commonly reported mechanism of injury due to the eccentric forces placed on the proximal rectus femoris during the swing phase of acceleration, as well during the deceleration phase, in which asynchronous muscle activation and force dissipation occurs from the muscle belly to the tendon. 2,11,13,18 The frequency, characteristics, and optimal treatment modalities for athletes sustaining proximal rectus femoris injuries remain largely unknown. The purpose of this investigation was to (1) systematically review the literature to better understand the prevalence, sporting activity, injury mechanisms, and treatment of patients with fullthickness proximal rectus femoris injuries and to (2) provide prognostic information regarding the rate and timing of return-to-play (RTP), to better inform clinicians when counseling patients and framing athletes' expectations.…”

“… 2 , 19 In the kicking athlete, the tendon is maximally elongated during hip extension and knee flexion, placing the muscle at risk for tearing or avulsion proximally during rapid contraction. 15 , 17 , 18 Moreover, abrupt arrest of the kicking motion during the strike phase further increases the risk of injury, such as when a kick is blocked by an opponent. 7 , 8 , 28 In nonkicking athletes, sprinting is a commonly reported mechanism of injury due to the eccentric forces placed on the proximal rectus femoris during the swing phase of acceleration, as well during the deceleration phase, in which asynchronous muscle activation and force dissipation occurs from the muscle belly to the tendon.…”

“… 7 , 8 , 28 In nonkicking athletes, sprinting is a commonly reported mechanism of injury due to the eccentric forces placed on the proximal rectus femoris during the swing phase of acceleration, as well during the deceleration phase, in which asynchronous muscle activation and force dissipation occurs from the muscle belly to the tendon. 2 , 11 , 13 , 18 …”