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Proximal rectus femoris tendon avulsion

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Proximal rectus femoris tendon avulsions are rare

  • stated as accounting for approximately 1.5% of sports related hip lesions (1)
  • more common in athletes practicing sports that involve sprinting and kicking
    • for example athletics, football, rugby, and soccer
      • lesions most commonly occur during hip hyperextension and knee flexion or as a result of a sharp eccentric contraction of the quadriceps
  • cause of these tendinous tears is unknown

Clinical features and investigation:

  • acute cases often present with pain located inferior to the anterior inferior iliac spine (origin of proximal arm of the rectus femoris), tenderness, and bruising
    • may cause weakness, pain, and discomfort when the knee is extended against resistance

  • chronic cases may result in
    • weakness with knee extension and hip flexion
    • tenderness over the anterior hip

  • magnetic resonance imaging is the preferred method to confirm a proximal rectus femoris avulsion
    • if operative management is considered then preoperative evaluation of tear extension and muscular retraction with magnetic resonance imaging is recommended

Management:

  • standard treatment is nonoperative management (2,3)
  • however good results have been reported with surgical treatment in a select group of patients, particularly high-level athletes

Notes:

  • rectus femoris
    • the only biarticular muscle of the quadriceps muscle group
    • contains a high percentage of rapidcontraction muscular fibers
    • the most frequently torn muscle within this group.

Reference:

  • Kannus P, Natri A. Etiology and pathophysiology of tendon ruptures in sports. Scand J Med Sci Sports 1997;7: 107-112.
  • García VV et al. Surgical treatment of proximal ruptures of the rectus femoris in professional soccer player. Arthroscopy 2011;27:e117- e118 (abstr, suppl).
  • Langer PR, Selesnick H. Proximal rectus femoris avulsion in an elite, Olympic-level sprinter. Am J Orthop 2010;39: 543-547

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