Background:Proximal rectus femoris (PRF) tears are relatively rare injuries among top-level athletes. PRF injuries can be avulsions of both tendon heads (direct and reflected heads) or of a single head, and some have a tendency to progress to recurrent injuries.Purpose:To describe a series of operatively treated PRF ruptures in professional soccer players.Study Design:Case series; Level of evidence, 4.Methods:Nineteen cases of PRF injuries (18 patients, 1 bilateral) in professional soccer players who were treated surgically were retrospectively reviewed. Perioperative findings with return-to-play data were recorded.Results:Of the PRF injuries, 10 total avulsions (both heads) and 9 single-head tears were seen on magnetic resonance imaging and were later confirmed during surgery. All 18 patients returned to their preinjury level of play (mean follow-up, 2.8 years [range, 1-11 years]).Conclusion:The repair of PRF tears in professional soccer players yielded good results and allowed all patients to return to their preinjury level of play.

Background and Aims: An anterior mid-tibial stress fracture is an uncommon, but possibly career threatening condition for an athlete. We wanted to evaluate the results of the surgical treatment of this notorious stress fracture and compare two different surgical methods. Material and Methods: Forty-nine anterior mid-tibial stress fractures were treated surgically in 45 patients during the years 1985–2005. All the patients were athletes, mainly runners. The mean age of the patients was 26 years. Thirty-four of the fractures occurred in men and 15 in women. The first method of treatment (anteromedial and lateral drilling) was used in 20 operations and the second method (laminofixation) in 29 operations. Results: Good results were achieved with drilling in only 50% of the operations, where as with laminofixation good results were achieved in 93% of operations. This difference was statistically significant (p = .002). Healing of the stress fracture after laminofixation occurred in less than 6 months. The length of the plate used in the laminofixation had no effect on the end result. Conclusions: An anterior mid-tibial stress fracture may often lead to delayed union or non-union in vigorously training athletes. Surgical treatment with laminofixation proved to be superior to tibial fracture site drilling.

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Patellar instability is a multifactorial disorder. Patella alta is strongly associated with patellar instability. We hypothesize that procedures of the patellar tendon such as medialization may shorten the patellar tendon. In this retrospective study, 41 patients with patellar instability were treated operatively with a patellar tendon medialization procedure. Twenty-eight knees were treated using a modified Roux-Goldthwait method and 16 using a modified Elmslie-Trillat method. The patients were followed 2-7 years after the operation. Pre- and post-operative x-rays were analyzed with particular emphasis on patellar tendon length, patellofemoral congruence angle and osteoarthritis. The final clinical outcome was assessed using the Lysholm score and clinical examination. In both groups patients were generally satisfied with the result of the operation and there was no significant difference in Lysholm scores at follow-up. However, patellofemoral osteoarthritic changes increased in both groups compared with the pre-operative status. The patellar tendon length was reduced in both groups, but significantly, by 7%, in the Roux-Goldthwait group. We conclude that patellar tendon shortens after a Roux-Goldthwait procedure.