Chronic Avulsion of the Proximal Rectus Femoris Tendon with Significant Defect: A Successful Surgical Management

Abstract

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.

Biomechanical Comparison Between Double-Row Repair and Soft Tissue Tenodesis for Treatment of Proximal Rectus Femoris Avulsions

“…Although there is a paucity of literature reporting the postoperative outcomes after suture anchor repair using the suture-bridge technique, previous clinical studies have reported satisfactory postoperative results for both tenodesis and suture anchor repair techniques using the single row technique 1,4,7,13,15,18,[20][21][22][23] (Table 3). Kayani et al 15 compared the postoperative clinical outcomes of tenodesis and suture anchor repair techniques for PRF injuries in professional athletes and reported that the tenodesis group had a shorter time to return to play at previous competitive level and a lower recurrence rate than the suture anchor repair group.…”

“…17 As the prevalence of reported PRF injuries is low, PRF injuries are often overlooked and undertreated, leading to chronic injuries with sustained symptoms and additional time lost from sports for the athletes. 9,1,6 Traditionally, PRF injuries in high-level athletes have been treated nonoperatively, utilizing a combination of stretching, ice, manual therapies, and gradual strengthening, with multiple studies reporting favorable clinical outcomes. 5,6,19 However, nonoperative treatment is often unsuccessful in high-level athletes for the reasons of not restoring the native anatomy of the PRF and scarring of the tendon, resulting in the recurrence of symptoms, diminished strength, decreased function, sustained pain, and cramping.…”

“… 17 As the prevalence of reported PRF injuries is low, PRF injuries are often overlooked and undertreated, leading to chronic injuries with sustained symptoms and additional time lost from sports for the athletes. 9 , 1 , 6 …”

Avulsion Injuries and Ruptures of the Proximal Rectus Femoris in Skeletally Mature, High-Level Athletes

“…Athletes generally maintain full passive hip range of motion 3,19 and are able to perform a straight leg raise with discomfort 2 . Quadriceps weakness is generally appreciated with resisted knee extension, especially in chronic cases 3,5,9,27 .…”

“…Because of the low prevalence of reported injuries to the proximal rectus femoris, to our knowledge, no current consensus exists guiding optimal management in high-level athletes 3,8 . Moreover, proximal avulsions and ruptures are often overlooked and undertreated, leading to chronic injuries and additional time lost from sport 3,5,9 . The purpose of this article is to provide a concise overview of the prevalence, the anatomy, the mechanisms of injury, the diagnostic workup, the treatment options, and the reported outcomes and complications that occur with treatment of proximal rectus femoris avulsion injuries and ruptures in high-level athletes.…”