Successful conservative treatment for a subtotal proximal avulsion of the rectus femoris in an elite soccer player

Should proximal ruptures of the anterior rectus femoris muscle be treated surgically?

“…Thirteen articles (describing a total of 51 patients) reported conservative treatment. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 The aim of conservative treatment was in all cases to combat hematoma (icing, compression, discharge, cessation of activity, puncture-evacuation) and to optimize musculo-tendinous healing (rehabilitation, ultrasound, etc). The general principles of the rehabilitation protocols (when they were detailed in the articles) were: Limit fibroblastic production with ultrasound and by administering no non-steroidal anti-inflammatory drugs during the first 48 h. Orient the healing process by gentle early rehabilitation, stretching, and isometric, then isotonic, and concentric, then eccentric, contractions, in discharge, then in charge.…”

“…These results were corroborated by others. 8 , 10 , 11 Hsu et al. 7 treated 2 high-performance athletes without surgery who returned to the same sport at the same level at 3 months.…”

Bicortical Titanium Tenodesis Button With Double-Row Fixation for the Treatment of Proximal Rectus Femoris Avulsion: Review of Literature and Surgical Technique

“…In the literature, there is great variability in how nonoperative patients are managed, but the outcomes of most patients showed low reinjury rates and a full return to elite-level play. 4,6,8,14 Gamradt et al 8 conducted the largest study of conservatively managed patients, 16 elite-level American football players, with direct head injuries of the RF and noted a recurrence rate of 18%. Similarly to nonoperative treatments, various surgical methods have been reported in the treatment of RF avulsion fractures.…”

“… 2 , 13 US has been suggested as a more rapid and inexpensive imaging modality for diagnosis 13 ; however, authors have suggested that US lacks the resolution to grade such injuries regardless of skill. 6 However, US could be useful in conjunction with physical examination findings in the on-field diagnosis of RF avulsion injuries to prevent a missed or delayed diagnosis. 1 US provides an early and rapid idea of hematomas and avulsions, which could be used to better screen on-field injuries and guide further management.…”

“…Rectus femoris (RF) avulsion fractures are well documented in athletic adolescent populations and thought to be rare in skeletally mature populations. 1 RF avulsions in adult populations are reported in professional soccer 1 , 2 , 3 , 4 , 5 , 6 , 7 and football players 8 but are noted to be exceptionally rare. Although intramuscular quadriceps strains are common, the rarer proximal RF avulsion injury, with a reported incidence of 0.5%, is a more serious injury that can cause significant pain and loss of function in the knee and hip joints.…”