Rectus femoris injury

This 45-year-old man presented three months after an injury to his left quadricep (his dominant leg). He describes experiencing acute pain while kicking a ball. This was enough to prevent him from being able to continue to play and made him limp for about two weeks. His symptoms have now largely settled however he has become increasingly aware of an unusual appearance to his quadricep. On examination there is an obvious defect in his anterior thigh. This is more apparent when he extends his knee against resistance. He has no significant tenderness, loss of movement or reduced function.

An ultrasound scan shows a high-grade tear of his rectus femoris. There is complete disruption of the distal aponeurosis of the left rectus femoris muscle. The muscle is retracted by 135mm. The quadriceps tendon and the remaining quadriceps muscles (not shown) appeared normal.

Injuries to the rectus femoris are relatively common. They are generally best treated with time and rehabilitation. Despite what are often quite obvious clinical and radiological findings, surgical treatment is rarely needed. Players should be reassured that they should expect to regain normal function – but that the appearance of the muscle will not return to normal.

The rectus femoris is at a relatively high risk of injury as it is biarticular and because it has a high prevelance of type II muscle fibres. Injuries generally occur during accelerations, while jumping or kicking or during any other activities involving contraction against resistance. While rehabilitation is generally the best treatment, this is not always successful. Surgery should be considered if the symptoms (pain, weakness and loss of function) persist for longer than six months (which is the longest time expected for healing). The injury can be complicated by symptomatic chronic myofascial injuries. These can be treated by excision of scar tissue.

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