Surgical Management of Rectus Femoris Avulsion Among Professional Soccer Players

Abstract

Background:Rectus femoris injuries are common among athletes, especially in kicking sports such as soccer; however, proximal rectus femoris avulsions in athletes are a relatively rare entity.Purpose/Hypothesis:The purpose of this study was to describe and report the results of an original technique of surgical excision of the proximal tendon remnant followed by a muscular suture repair. Our hypothesis was that this technique limits the risk of recurrence in high-level athletes and allows for rapid recovery without loss of quadriceps strength.Study Design:Case series; Level of evidence, 4.Methods:Our retrospective series included 5 players aged 31.8 ± 3.9 years with acute proximal rectus femoris avulsion injuries who underwent a surgical resection of the proximal tendon between March 2012 and June 2014. Four of these players had recurrent rectus femoris injuries in the 9 months before surgery, while 1 player had surgery after a first injury. Mean follow-up was 18.2 ± 12.6 months, and minimum follow-up was 9 months. We analyzed the age, sex distribution, physical examination outcomes, type and mechanism of injury, diagnosis, treatment and complications during surgery, postoperative follow-up, and time to return to play. The Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at 3-month follow-up, and isokinetic tests were performed before return to sports. A telephone interview was completed to determine the presence of recurrence at an average follow-up of 18.2 months.Results:At 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. Return to the previous level of play occurred at a mean of 15.8 ± 2.6 weeks after surgery, and none of the athletes suffered a recurrence. Isokinetic test results were comparable between both sides.Conclusion:The surgical treatment of proximal rectus femoris avulsions, consisting of resection of the tendinous part of the muscle, is a reliable and safe technique allowing a fast recovery in professional athletes.

Operative Treatment of Proximal Rectus Femoris Injuries in Professional Soccer Players: A Series of 19 Cases

“…The tear can be sutured, 6 the proximal tendon heads of the rectus femoris can be excised, or the tendon can be reattached and secured with suture anchors. 9,19,20 According to our results and those of others, 6,9,17,19 it seems that good outcomes may be expected after operative treatment in most cases of complete or 1-tendon PRF tears. However, in the acute phase, surgery is technically easier compared with surgery performed in the chronic phase or after recurrent injuries.…”

“…In elite soccer, in which the athlete has to perform forceful kicking and maximal sprinting, surgical restoration of the injured tendon seems to be a viable choice for total avulsions of the PRF. 1,9,11 Previously, Garcia et al 6 and Sonnery-Cottet et al 17 reported a total of 9 cases (4 and 5 patients, respectively) of the PRF treated successfully by surgery in professional soccer players, although the patients that they treated were older compared with our participants. In addition, return to play seems to be over 3 months after PRF reattachment even if platelet-rich plasma is applied during surgery.…”

“…Our results of return to play are in line with those of earlier reports that examined the operative treatment of PRF injuries in smaller sample sizes with the same sports and levels of competition. 6,17,19…”

“…More recently, several authors have reported good results with the operative treatment of PRF avulsions in high-level athletes. 2,17 Sonnery-Cottet et al 17 recommended the operative treatment of injuries involving both heads of the rectus femoris.…”

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

“…None of the study patients treated with primary tenodesis for proximal rectus avulsion femoris injuries developed injury recurrence. These findings are consistent with those of Sonnery-Cottet et al, 32 who reviewed outcomes in 4 patients with recurrent injuries and 1 with a primary injury of the proximal rectus femoris that were treated with surgical excision of the proximal tendon remnant and muscle-to-muscle suture repair. The authors stated that all patients returned to their preinjury levels of function at 15.8 ± 2.6 weeks, with no injury recurrence at 3-month follow-up.…”