Proximal Rectus Femoris Avulsion: Ultrasonic Diagnosis and Nonoperative Management

Abstract

Objective: To present a case of ultrasonic diagnosis and nonoperative management of a complete proximal rectus femoris avulsion in a National Collegiate Athletic Association Division 1 soccer goalkeeper.Background: While delivering a goal kick, a previously uninjured 24-year-old collegiate soccer goalkeeper had the sudden onset of right anterior thigh pain. He underwent rehabilitation with rapid resolution of his presenting pain but frequent intermittent recurrence of anterior thigh pain. After he was provided a definitive diagnosis with musculoskeletal ultrasound, he underwent an extended period of rehabilitation and eventually experienced complete recovery without recurrence.Differential Diagnosis: Rectus femoris avulsion, rectus femoris strain or partial tear, inguinal hernia, or acetabular labral tear.Treatment: Operative and nonoperative options were discussed. In view of the player's recovery, nonoperative options were pursued with a good result.Uniqueness: Complete proximal rectus femoris avulsions are rare. Our case contributes to the debate on whether elitelevel kicking and running athletes can return to full on-field performance without surgery.Conclusions: Complete proximal rectus femoris avulsions can be treated effectively using nonoperative measures with good preservation of function even in the elite-level athlete. In addition, musculoskeletal ultrasound is an excellent tool for onsite evaluation and may help guide prognosis and management.

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

“…20 The treatment of any PRF injury can be nonoperative in sedentary people and in physically low-demand athletes. 4,8 As activity levels vary between different sports, even top-level American football players have been treated without surgery with good results. 5 However, in the study of Gamradt et al, 5 only avulsions at the anterior inferior iliac spine were shown, without mentioning retraction of the reflected head.…”

Proximal Rectus Femoris Avulsion Repair

“…This procedure is not indicated for nondisplaced or minimally displaced avulsions, musculotendinous tears with minimal or no muscular retraction, and chronic tears in low-demand elderly patients without pain who have an acceptable functional level because of excellent results with conservative management. 4,9,10 It is the opinion of the senior author (C.P-G.) that patients in whom nonoperative treatments fail (continued pain or weakness) for more than 3 months may also be considered for surgical treatment. Indications and contraindications are summarized in Table 1.…”

Nonoperative Management of a Severe Proximal Rectus Femoris Musculotendinous Injury in a Recreational Athlete: A Case Report

“…Eighteen percent of the NFL players did suffer a recurrence of symptoms however. A case report involving a similar proximal rectus femoris injury (direct head torn and indirect head avulsed) in a collegiate Division 1 soccer player described a more than 20‐week nonsurgical rehabilitation program before a return to full play [9]. In this report and others in the literature, there are scant details about the nonsurgical rehabilitation program for this kind of injury.…”

“…These kinds of injuries are rare, representing only 0.5% of all reported hip and pelvic injuries [8]. To our knowledge, there are significantly fewer numbers of documented cases involving both direct and indirect head avulsions at the musculotendinous junction [4,9]. Such injury statistics could change with the increasing number of players involved socially and recreationally in other sports in addition to kickball, such as foot volley, sepak takraw, futsal, hacky sack, footbag net, footgolf, kegball, and human foosball.…”