Nonoperative Management of a Severe Proximal Rectus Femoris Musculotendinous Injury in a Recreational Athlete: A Case Report

Park, C. Kevin; Zlomislic, Vinko; Du, Jiang; Huang, Brady K.; Chang, Eric Y.; Chang, Douglas G.

doi:10.1016/j.pmrj.2018.05.005

Cited by 12 publications

(20 citation statements)

References 14 publications

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“…Clinical evaluation may reveal significant thigh swelling, focal tenderness over the anterior inferior iliac spine, generalized anterior thigh tenderness and an antalgic or stiff-legged gait. 8 , 15 , 16 A palpable gap may be felt in the proximal aspect of the anterior thigh, although this may not always be pronounced. In some patients, a sizeable mass in the anterior thigh may be seen with muscle retraction, representing the reflected head of the rectus femoris.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Non-operative treatment follows the principles of soft tissue injury management including rest, ice, compression, and protected weight-bearing. 15 Rehabilitation at the early stage includes pain relieving modalities, gentle range of motion, and functional movement training. Gentle strength training is initiated with isometric contractions and light eccentric exercises.…”

Section: Non-operative Treatmentmentioning

confidence: 99%

“…Non-operative treatment of proximal rectus femoris avulsion injuries is associated with highly-variable periods of convalescence, with studies reporting return to preinjury level of sporting function at six weeks to one year after injury. 15 The associated loss of muscle strength and functional decline with non-operative management is associated with poor return to baseline activity and decreased functional performance. 15 , 18 , 28 , 29 Non-operative management is associated with residual scarring and tethering of the avulsed tendon stump to adjacent soft tissues, with injury recurrence in 18% of cases.…”

Section: Non-operative Treatmentmentioning

confidence: 99%

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The management of proximal rectus femoris avulsion injuries

et al. 2020

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Injuries to the quadriceps muscle group are commonly seen in sporting activities that involve repetitive kicking and high-speed sprinting, including football (soccer), rugby and athletics. The proximal rectus femoris is prone to avulsion injuries as rapid eccentric muscle contraction leads to asynchronous muscle activation and different force vectors through the straight and reflected heads. Risk factors for injury include previous rectus femoris muscle or hamstring injury, reduced flexibility of the quadriceps complex, injury to the dominant leg, and dry field playing conditions. Magnetic resonance imaging (MRI) is the preferred imaging modality as it enables the site of injury to be accurately located, concurrent injuries to be identified, preoperative grading of the injury, and aids surgical planning. Non-operative management is associated with highly variable periods of convalescence, poor return to preinjury level of function and high risk of injury recurrence. Operative treatment of proximal rectus femoris avulsion injuries with surgical repair or surgical tenodesis enables return to preinjury level of sporting activity and high functional outcomes. Surgical tenodesis of proximal rectus femoris avulsion injuries may offer an avenue for further reducing recurrence rates compared to direct suture anchor repair of these injuries. Cite this article: EFORT Open Rev 2020;5:828-834. DOI: 10.1302/2058-5241.5.200055

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Section: Clinical Featuresmentioning

confidence: 99%

Section: Non-operative Treatmentmentioning

confidence: 99%

Section: Non-operative Treatmentmentioning

confidence: 99%

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The management of proximal rectus femoris avulsion injuries

et al. 2020

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“…Nonoperative management is typically the first line of treatment for most patients with proximal rectus femoris injuries, although surgical management is considered for patients with high-grade injuries, as in professional athletes or patients whose nonoperative management has failed. 14,24,29,32 Surgical repair with suture anchors aims to reattach the avulsed proximal rectus femoris tendon to its native bed to restore preinjury anatomic architecture and muscle tension. However, this technique is associated with prolonged periods of rehabilitation and highly variable risk of injury recurrence on return to full sporting activity.…”

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Outcomes of Surgical Repair Versus Primary Tenodesis for Proximal Rectus Femoris Avulsion Injuries in Professional Athletes

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Background: Surgical repair of proximal rectus femoris avulsion injuries is associated with prolonged periods of rehabilitation and highly variable risk of injury recurrence. Surgical tenodesis of these injuries is often reserved for recurrent injuries or revision surgery. To our knowledge, the outcomes of proximal rectus femoris avulsion injuries treated with surgical repair versus primary tenodesis have not been previously reported. Hypothesis: Primary tenodesis of proximal rectus femoris avulsion injuries is associated with reduced risk of injury recurrence as compared with surgical repair. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 25 patients (22 male and 3 female) who underwent surgical repair versus 30 patients (26 male and 4 female) who received primary tenodesis for proximal rectus femoris avulsion injuries. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 27.9 months (range, 24.0-31.7 months) from date of surgery. Results: All patients returned to their preinjury levels of sporting activity. Primary tenodesis was associated with earlier return to preinjury level of sporting function as compared with surgical repair (mean ± SD, 12.4 ± 1.6 vs 15.8 ± 2.2 weeks; P < .001) and reduced risk of recurrence (0% vs 16%; P < .001). At 1-year follow-up, there was no difference in surgical repair versus primary tenodesis relating to patient satisfaction scores (12 very satisfied and 13 satisfied vs 16 very satisfied and 14 satisfied; P = .70), isometric quadriceps strength (95.6% ± 2.8% vs 95.2% ± 6.3%; P = .31), Tegner scores (median [interquartile range], 9 [8-9] vs 9 [8-9]; P = .54), and lower extremity functional scores (73 [72-76] vs 74 [72-75]; P = .41). High patient satisfaction, quadriceps muscle strength, and functional outcome scores were maintained and remained comparable between treatment groups at 2-year follow-up. Conclusion: Primary tenodesis was associated with reduced time for return to preinjury level of sporting function and decreased risk of injury recurrence when compared with surgical repair for proximal rectus femoris avulsion injuries. There were no differences in patient satisfaction, functional outcome scores, and quadriceps muscle strength between the treatment groups at 1- and 2-year follow-up.

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“…Existen en la literatura ejemplos de tratamiento no quirúrgico de lesiones de recto anterior (505), pero se refieren a lesiones graves, que no es el caso que nos ocupa. Sin embargo pueden servir como base para la recuperación de esta lesión pero reduciendo los tiempos de cada fase.…”

Section: Justificación De La Readaptación De La Lesión De Recto Anterunclassified

Plan de entrenamiento orientado a la prevención de lesiones en fútbol

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No te rindas, por favor no cedas, aunque el frío queme, aunque el miedo muerda, aunque el sol se esconda, y se calle el viento, aún hay fuego en tu alma, aún hay vida en tus sueños, porque la vida es tuya y tuyo también el deseo, porque cada día es un comienzo nuevo, porque esta es la hora y el mejor momento, porque no estás sola, ¡Porque yo te quiero! Mario Benedetti A mis hijas Elena y Paula, que en este momento no entenderán mis palabras. Os dedico más de un año de esfuerzo y trabajo duro. Aunque sé que mi trabajo más importante es con vosotras y espero estar a la altura. Os aseguro que pondré todo mi empeño en inculcaros el valor del esfuerzo, la superación, el respeto, el cuidado de las cosas, el orden, la tolerancia, la empatía, el amor a los demás y a vosotras mismas,… Y que intentaré que siempre seáis felices, como lo sois ahora. A Cristi… mi mujer, mi compañera, mi amiga, mi apoyo, mi fuerza,… mi TODO. AGRADECIMIENTOS Me gustaría dejar constancia de mi agradecimiento a aquéllas personas que han contribuido a que este trabajo sea una realidad. En especial: A mi tutor Carlos Vallés, por sus revisiones, sus aportaciones, sus palabras de ánimo cada vez que ha surgido un problema y por implicarse más de lo que se le pedía. A Fernando García, fisioterapeuta, por ayudarme en las evaluaciones en su tiempo libre, por mantenerme al tanto del estado del jugador y por soportar mi insistencia en algunos momentos. A Dioni González, responsable de los servicios médicos, por la confianza que ha tenido en mí y en mi trabajo antes siquiera de empezar y por abrirme las puertas del Club. A Francisco Javier Fernández Navarro, por ayudarme con el uso del gestor bibliográfico y por su disponibilidad cuando he necesitado su ayuda. A Antonio López, compañero de promoción del Máster y Entrenador Personal, por sus desinteresados y valiosos consejos y orientaciones sobre la disquinesia escapular. A mi hermano Jose, mi referencia en cuanto a rigor, orden y perfección en lo académico, por las charlas y consejos sobre formato y por resolverme cualquier duda o problema que le he planteado con premura y eficacia. A mi hermano David, un ejemplo de constancia, por sus cariñosos consejos que no siempre he sabido entender pero que nunca he dejado de apreciar. A mis padres, Pepe y Dori, por la educación que me han dado, por inculcarme el valor del respeto, el esfuerzo y la responsabilidad, por permitirme crecer en un entorno sano y lleno de amor. A mi padre por ser exigente conmigo y no permitir que me acomodase nunca. A mi madre por renunciar a sus sueños por darnos la mejor educación que ha sabido a mis hermanos y a mí. Es inútil tratar de expresar mi agradecimiento porque no existen palabras tan grandes. A mi mujer, Cristi, por darme su tiempo libre para que yo pudiese leer y escribir, por hacer todo aquello que no he hecho yo mientras estaba estudiando, por su infinita paciencia cuando yo perdía la mía o estaba cansado, por aguantar con una sonrisa mis monotemáticas conversaciones, por ser mi modelo de vida, por hacerme mejor persona, po...

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Nonoperative Management of a Severe Proximal Rectus Femoris Musculotendinous Injury in a Recreational Athlete: A Case Report

Cited by 12 publications

References 14 publications

The management of proximal rectus femoris avulsion injuries

The management of proximal rectus femoris avulsion injuries

Outcomes of Surgical Repair Versus Primary Tenodesis for Proximal Rectus Femoris Avulsion Injuries in Professional Athletes

Plan de entrenamiento orientado a la prevención de lesiones en fútbol

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