The management of proximal rectus femoris avulsion injuries

Abstract

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

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

“…7,16,29 Proximal rectus femoris injuries are commonly reported as a result of movements associated with rapid eccentric muscle contraction and acceleration/deceleration, such as kicking or sprinting. 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. 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.…”

“… 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 …”