Proximal rectus femoris tendon avulsion

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