Background: Rupture of the proximal rectus femoris tendon has been well documented in the literature because of a bony avulsion of the anteroinferior iliac spine predominantly in the active adolescent population. Most of these ruptures are treated non-operatively with good functional outcomes. However, when conservative treatments fail, surgery is an option.Purpose: To describe a rare case of successful surgical management of a chronic ruptured proximal rectus femoris tendon. Results:The patient progressively returned to competitive sports without any symptoms at four months post tendon repair. At final follow-up two years after surgical repair, the patient has a University of California, Los Angeles activity score of 10, and a Non-Arthritic Hip Score of 95/100. Conclusion:Tendon avulsion of the rectus femoris muscle is a rare entity in the adult population. Surgical management of chronic tendon avulsion of the rectus femoris proved to be efficient and can be recommended when conservative treatment fails.

Adult periacetabular osteotomy (PAO) was originally performed through the classic Smith-Petersen approach for optimal operative visibility and acetabular fragment correction. Evolution towards an abductor-sparing technique significantly lowered the post-operative morbidity. The rectus-sparing approach represents a step further, but the innervation of the rectus femoris is theoretically more at risk. Although the topographic anatomy of the femoral nerve has been well described, it was never studied with specificity to surgical landmarks. The femoral nerve’s spatial relation with the anterior-inferior iliac spine (AIIS) and the amount of possible dissection in the rectus femoris and iliopsoas interval is uncertain. Seven formalin-preserved human cadaveric specimens without history of inguinal injury or surgery were dissected using the distal limb of an iliofemoral approach. The level of entry of motor innervation was measured and number of branches to the rectus femoris was noted. The average longitudinal distance from the AIIS to the first motor nerve to the rectus femoris was 8.6 ± 1.4 cm. The number of branches varied between 1 and 4 with the most common innervation pattern being composed of two segments. Dissection medial to the rectus femoris should not be carried out further than 7 cm distal to the AIIS and stretching of that interval during surgical exposure should be done cautiously. The clinical efficiency of the rectus-sparing approach should be studied further in order to confirm its advantage over the classic direct anterior approach. The study provides a better understanding of the localization and the anatomical variations of the structures encountered at the level of and below the AIIS. It also assesses the relative risk of denervation of the rectus femoris during PAO through the rectus-sparing approach. The authors recommend that the dissection medial to the rectus femoris should be carried out no further than 7 cm distal to the AIIS and stretching of that interval during surgical exposure should be done cautiously.

Purpose and hypothesisThe aim of this study was to evaluate the hip joint range of motion after different capsular plication. The study hypothesis proposed that capsular plication after hip arthroscopy may reduce hip external rotation and thus prevent the hip joint instability created by arthroscopic capsulotomies.MethodsSix fresh frozen human cadavers were studied in the intact state (5 males, 1 females) for a total of 12 non-deformity hips tested. They were fixed to the operating room table using a custom-made apparatus. Three Steinman pins were inserted, the first into ASIS, a parallel pin into the distal femur proximal to inter-epicondylar axis and the third pin into the lateral epicondyle. Simulation of arthroscopic capsulotomies was done progressively with simulation of three capsular plication techniques. The first plication technique consisted of a primary plication shift of the antero-lateral capsule. The distal-medial arm of the iliofemoral ligament was shifted toward the proximal-lateral arm. The second plication technique consisted in adding a longitudinal arm to the capsulotomy, between the lateral arm and the medial arm of the iliofemoral ligament, to create a T-shaped capsulotomy. The resulting two triangular capsular flaps were overlaid onto each other by approximately 5 mm, plicated fully and tighly sutured in a double-breast manner. The third plication technique, called redrapping, consisted in excising the inferior capsular triangular flap (previously made in the second technique), and suturing the latero-anterior superior capsular flap to the medial arm of the iliofemoral ligament, superimposing the capsular edges for closure. External rotation of the hip at 0°, 15° and 30° of flexion were obtained after the capsulotomy and each capsular plication technique to quantify the increase in hip stability after plication. Data were assessed using a two-way repeated measure analysis of variance (ANOVAs) and Student’s T-test when necessary to determine if the change in external rotation was significantly different.ResultsAfter capsulotomy, external rotation averaged 26.3°, 29.1° and 31.1° at 0°, 15° and 30° of flexion. With the primary plication shift, external rotation averaged 24.9°, 30.3° and 34.0°. With the two-triangle technique, external rotation averaged 26.1°, 31.9° and 33.3°. With the re-draping technique, external rotation averaged 25.8°, 30.9° and 32.0°. A significant relationship was found between «Plication Technique» and «Angle of flexion» factors for the measured angle of external rotation (P = 0.04).A decomposition of the interaction showed that external rotation decreased at 0° of hip flexion and increased as the hip flexion angle increased. The only significant difference found corresponded to the two triangles technique at 15° flexion (mean difference compared to the non-repaired state = 2.8° ± 3.8° or 8.8% increase in external rotation; P = 0.03).ConclusionsDifferent techniques of capsular plication result in a non-significant increase in hip external rotation when compared to unrepa...