Proximal Rectus Femoris Avulsion Repair

Abstract

Proximal rectus femoris tendon avulsions are rare and occur mostly in male athletes. Currently, the standard of care for complete tendinous avulsions of the direct arm of the rectus femoris is nonoperative treatment. However, surgical repair may be considered in high-level athletes who have a high demand for repetitive hip flexion performed in an explosive manner or in patients in whom nonoperative treatment has failed. The purpose of this technical note is to describe the method for surgical repair of the proximal direct arm of the rectus femoris to its origin at the anterior inferior iliac spine using suture anchors.

Operative Treatment of Proximal Rectus Femoris Injuries in Professional Soccer Players: A Series of 19 Cases

“…According to our experience, MRI can detect patients who could benefit from surgery by showing enlarged diffuse hematoma at the original insertion of the PRF as a sign of a ruptured fascia as well as a retracted tendon stump. Dean et al 2 postulated that nonoperative treatment leads to good results if the PRF tear has minimal retraction, with which we also agree. When PRF tears have minimal retraction and the fascia over the ruptured tendon is intact, nonoperative treatment leads to good results.…”

“…These indications were high-demand patients (high-level athletes) and failure of nonoperative treatment (pain and weakness for over 3 months), whereas contraindications were described as nondisplaced avulsions, tears without retraction, and low-demand patients in whom chronic tears do not interfere with normal daily function. 2 These indications are also in line with our practice.…”

“…6 While total avulsions of the PRF are treated operatively, the treatment strategy of PRF partial tears could have more options. Dean et al 2 proposed the indications and contraindications for the surgical treatment of PRF injuries. These indications were high-demand patients (high-level athletes) and failure of nonoperative treatment (pain and weakness for over 3 months), whereas contraindications were described as nondisplaced avulsions, tears without retraction, and low-demand patients in whom chronic tears do not interfere with normal daily function.…”

“…More recently, several authors have reported good results with the operative treatment of PRF avulsions in high-level athletes. 2,17 Sonnery-Cottet et al 17 recommended the operative treatment of injuries involving both heads of the rectus femoris.…”

Outcomes of Surgical Repair Versus Primary Tenodesis for Proximal Rectus Femoris Avulsion Injuries in Professional Athletes

“…In the present study, surgical repair of proximal rectus femoris avulsion injuries enabled return to preinjury level of sporting function at 15.8 ± 2.2 weeks, which is more favorable than reports from existing studies using smaller sample sizes of patients with similar preinjury levels of activity. 11,15,20,23,34,37 Irmola et al 20 followed 4 professional soccer players and 1 national-level hurdler who underwent surgical repair of complete proximal rectus femoris avulsion injuries and reported that the median time for return to sporting activity was 9 months (range, 5-10 months). However, time from injury to surgical intervention was 18 to 102 days, which may have adversely affected postoperative rehabilitation time.…”