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Plain radiograph showing proximal rectus femoris avulsion injury from the anterior inferior iliac spine.
Source publication
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 vecto...
Context in source publication
Context 1
... pelvic or hip radiographs are often the first line of imaging and may reveal avulsion fractures from the anterior inferior iliac spine (Fig. 2). In some patients with delayed presentations, chronic injuries and surgical repair of the avulsed proximal rectus femoris tendon, additional calcification may be seen around the proximal suture anchor repair site. 3,18 Further imaging in patients with proximal rectus femoris avulsion injuries is often undertaken using ultrasound scan ...
Citations
... This can be explained by the characteristic of the training session performed (e.g. composed of jumping, high-speed sprinting, plyometrics) which can further overload the anterior musculature of the LL [56,57]. This result shows a relationship of dependence between the tissue repair process and the higher concentration of pixels in the extreme value bands of the lower limbs Tsk. ...
... Many studies highlight patients having initial nonoperative treatment that prevented RTS due to ongoing symptoms and therefore progressed to surgical repair. 6,9,26,31,32 Lempainen et al, 26 in their series of 19 cases treated surgically, had seven patients initially treated nonoperatively who had recurrence of injury and proceeded to surgery. Reinjury is a considerable risk, with Orchard 12 studying 163 quadriceps injuries in Australian football and found previous quadriceps injury within eight weeks had a 15.61 risk ratio for reinjury (95% confidence interval (CI) 10.27 to 23.74). ...
... These studies have found that operative treatment restores functional outcomes, reliable return to preinjury sporting level, and low risk of recurrence. 6,10,11,26,[31][32][33] Several operative techniques are described for proximal tendon repair including bone anchor fixation, tenodesis, and reconstruction. 6,9,11,32,3326 Lempainen et al 26 described bone suture anchor repair in 19 cases for proximal ruptures in professional soccer players, with a mean age of 23.4 years (15 to 31). ...
... Case series have suggested a course of anti-inflammatories may reduce the risk of heterotopic ossification. 31,42,43 Isolated direct head tendon injury. The direct head of rectus femoris blends into the anterior fascia of the muscle belly very quickly just below the AIIS. ...
Injuries to the quadriceps muscle group are common in athletes performing high-speed running and kicking sports. The complex anatomy of the rectus femoris puts it at greatest risk of injury. There is variability in prognosis in the literature, with reinjury rates as high as 67% in the severe graded proximal tear. Studies have highlighted that athletes can reinjure after nonoperative management, and some benefit may be derived from surgical repair to restore function and return to sport (RTS). This injury is potentially career-threatening in the elite-level athlete, and we aim to highlight the key recent literature on interventions to restore strength and function to allow early RTS while reducing the risk of injury recurrence. This article reviews the optimal diagnostic strategies and classification of quadriceps injuries. We highlight the unique anatomy of each injury on MRI and the outcomes of both nonoperative and operative treatment, providing an evidence-based management framework for athletes.
Cite this article: Bone Joint J 2023;105-B(12):1244–1251.
... 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. ...
... 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. We hypothesized that (1) injuries would be reported most frequently in athletes involved in sports requiring frequent and repetitive sprinting and kicking (ie, American football, track and field, rugby, soccer) and (2) operatively and nonoperatively treated athletes would experience similar RTP rates, timing, and complications. ...
Background
Characteristics regarding mechanism of injury, management, and return-to-play (RTP) rate and timing are important when treating and counseling athletes with rectus femoris tears.
Purpose
To systematically review the literature to better understand the prevalence, sporting activity, injury mechanisms, and treatment of patients with rectus femoris injury and to provide prognostic information regarding the rate and timing of RTP.
Study Design
Systematic review; Level of evidence, 4.
Methods
Following the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we queried PubMed/MEDLINE, Cochrane, OVID, EMBASE, and Google Scholar in March 2022 for studies reporting on athletes sustaining isolated, full-thickness tearing, or bony avulsion injuries to the proximal rectus femoris during sporting activity. Excluded were studies without evidence of full-thickness tearing or avulsion, with athletes sustaining concomitant injuries, or with injuries occurring from nonsporting activities. The percentage of athletes sustaining injuries was calculated based on sport, injury mechanism, and management (nonoperative versus operative).
Results
Of 132 studies initially identified, 18 were included, comprising 132 athletes (mean age, 24.0 ± 5.4 years; range, 12-43 years). The most common sporting activities were soccer (70.5%) and rugby (15.2%). The most reported mechanisms of injury were kicking (47.6%) and excessive knee flexion/forced hip extension (42.9%). Avulsion injuries were reported in 86% (n = 114) of athletes. Nonoperative management was reported in 19.7% of athletes, with operative management performed in 80.3%. The mean follow-up time was 21.4 ± 11.4 months (range, 1.5-48 months). The RTP rate was 93.3% (n = 14) in nonoperatively treated and 100% (n = 106) in operatively treated athletes, and the mean RTP time was 11.7 weeks (range, 5.5-15.2 weeks) in nonoperatively treated and 22.1 weeks (range, 14.0-37.6 weeks) in operatively treated athletes. Complications were reported in 7.7% (2/26) of nonoperatively treated and 18% (n = 19/106) of operatively treated athletes.
Conclusion
Full-thickness proximal rectus femoris injuries occurred most frequently in athletes participating in soccer and rugby secondary to explosive, eccentric contractions involved in kicking and sprinting. Operative management was performed in the majority of cases. Athletes who underwent operative repair had a 100% RTP rate versus 93.3% in athletes treated nonoperatively.
Purpose:
To determine the ultrasound imaging manifestations associated with subspine impingement (SSI), including the osseous and soft-tissue injuries adjacent to anterior inferior iliac spine (AIIS) and to investigate the diagnostic value of ultrasound for SSI.
Methods:
We retrospectively evaluated patients who attended the sports medicine department of our hospital and underwent arthroscopic treatment for femoroacetabular impingement (FAI) between September 2019 and October 2020, with preoperative hip joint ultrasound and CT examination within 1 month before surgery. All the FAI patients were divided into the SSI group and non-SSI group according to the clinical and intraoperative findings. The preoperative ultrasound and CT findings were assessed. The sensitivity, specificity, and positive predictive value (PPV) of some indicators were calculated and compared. Multivariable logistic regression and receiver operating characteristic curve (ROC) were also used.
Results:
A total of 71 hips were included, with a mean age of 35.4±10.4 years, 56.3% were women. Of these, 40 hips had clinically confirmed SSI. The bone morphology type III, heterogeneous hypoecho in anterosuperior joint capsule and the direct head of rectus femoris (dRF) tendon adjacent to AIIS on the Standard Section of dRF in ultrasound were associated with SSI. Among them, the heterogeneous hypoecho in the anterosuperior joint capsule had the best diagnostic value for the SSI (85.0% sensitivity, 58.1% specificity, AUC=0.681). The AUC of the ultrasound composite indicators was 0.750. The AUC and PPV of CT low-lying AIIS for the SSI diagnosis was 0.733 and 71.7%, which could be improved when CT was combined with the ultrasound composite indicators with AUC=0.831 and PPV=85.7%.
Conclusions:
Bone morphology abnormalities and soft-tissue injuries adjacent to the AIIS through sonographic evaluation were associated with SSI. Ultrasound could be used as a feasible method to predict SSI. The diagnostic value for SSI could be improved when ultrasound is combined with CT.
