Rectus Femoris Injuries: what and when? Ramon Cugat 8th MuscleTech etwork Workshop

1. Orthopaedic Surg & Sports Med Institute
ISAKOS Approved Teaching Center
@RamonCugat
Rectus Femoris

2. MEDICINE DOCTORS
Ramon CUGAT
Xavier CUSCÓ
Pedro ÁLVAREZ
Roberto SEIJAS
Gilbert STEINBACHER
David BARASTEGUI
Eduard ALENTORN-GELI
Eduardo MAURI
Betina NISHISHINYA
Juan Manuel BOFFA
Marta RIUS
Esther SALA
Manel LLUSÁ
Montse GARCIA-BALLETBO
Ana WANG-SAEGUSA
Wenceslao ESPINOSA
Patricia LAIZ
Jordi NAVARRO
Ana GIMENO
Silvia VIZCAÍNO
Eila RIVERA
Jordi CATALA
Miguel RENGIFO
CYTORI
BANC DE SANG I TEIXITS: Luciano RODRÍGUEZ
BTI: Eduardo ANITUA; Mikel SÁNCHEZ; Sabino PADILLA
VETERINARY DOCTORS
.- IVOT:
Alex TARRAGÓ
Ángel DURAN
Diego LÓPEZ
Javier TOTUSAUS
.- Universidad CEU-UCH de Valencia:
José Mª CARRILLO
Joaquín SOPENA
Mónica RUBIO
Mariluz ORTIZ
Mireia GARCIA
Belén CUERVO
Deborah CHICHARRO
Elena DAMIÁ
.- Universidad de Murcia:
José Joaquín CERÓN
Asta TVARIJONAVICIUTE
.- Universidad de Córdoba:
Juan Manuel DOMÍNGUEZ
Andrés FERNÁNDEZ
Mª del Mar GRANADOS
Rafael GÓMEZ
Rocío NAVARRETE
Juan MORGAZ
Setefilla QUIRÓS
Raúl ROMERO
Francisco Javier FUNES
Pilar MUÑOZ
María RODRÍGUEZ
Alfonso BLANCO
.-Universidad de Las Palmas de Gran Canaria:
José VILAR
Manuel MORALES
.-Universidad Católica de Valencia:
Iván SERRA
Carme SOLER
REHABILITATION DEPARTMENT
Silvia RAMON Elena MORALES Rafael ALCOVER
Ferran VIDIELLA Nieves LAMA Lorena PAINO
Xavier ÁLVAREZ Joan BOSCH Carles BOADA
Miguel MARÍN Juan Carlos ALEMANY Mireia TARÍN
M Ángeles ENGUITA Montserrat VERGES Rosa TEIXIDÓ Albert BADOSA

3. Muscle Injury Epidemiology
Season Number Affiliates
Number of
Injuries
Number of Muscle
injuries
2012-13 138.920 25.350 2.209 (8.71%)
2013-14 145.500 26.990 1.922 (7.12%)
2014-15 151.263 25.730 2.266 (8.80%)
Catalan Soccer Delegation’s Health Insurance Company under the Spanish Soccer
Federation

4. Muscle Injury Distribution 1 year
Anatomical Region Muscle Area Number
Thigh Hamstring Proximal 221 (34%)
Low 51 (7.8%)
Rectus Femoris 208 (32%)
Adductors 98 (15.07%)
Leg Gastrocnemius 72 (11.07%)
Catalan Soccer Delegation’s Health Insurance Company under the Spanish Soccer
Federation

5. Rectus Femoris
Rectus Femoris is very important in football
because the players sprinting and kikcking the
ball with this muscle
Rectus Femoris is the only muscle of the 4 that
compose the quadriceps which is biarticular like
the hamstrings and gastrocnemius

6. Proximal MTJ, direct head
22 FEB 2011 2 MAR 2011
‣ Muscle retraction
‣ (PRGF ®) Endoret ® is injected
‣ Muscle retraction does not increase respect to
previous control
‣ Absence of fluid collection. Advanced repair phase

7. Indications for Surgical Treatment
Active athlete
Functional weakness
Images studies: ultrasound & MRI

8. Tears that require Surgical Treatment
Avulsion from Antero-Inferior Iliac Spine
Complete rupture of MTPJ
Complete rupture MTDJ

9. Surgical Treatment of Rectus Femoris Tears
Year Surgeries N
2015 5
2016 3
Catalan Soccer Delegation’s Health Insurance Company under the Spanish Soccer
Federation

10. Area Surgeries N
Proximal 7
Distal 1
Surgical Treatment of Rectus Femoris Tears
Catalan Soccer Delegation’s Health Insurance Company under the Spanish Soccer
Federation

11. Avulsion from Antero-Inferior Iliac Spine
Longitudinal view Longitudinal view Comparative transversal view

12. Complete rupture of MTPJ
16 MAR 2016 25 AUG 2016

13. 26 NOV 2015 3 MAR 2016
Complete rupture of MTPJ

14. Complete rupture MTDJ

15. Surgical Techniques for Rectus Femoris Injuries
Reinsertion of the tendon for Avulsion from Antero-Inferior Iliac
Spine
Muscle-tendon suture for Complete rupture of MTPJ
Complete release, relaxation of the muscle belly & suture for
Complete rupture MTDJ

16. Reinsertion of the tendon
(Avulsion from the Antero-Inferior Iliac Spine)

17. Reinsertion of the tendon
(Avulsion from the Antero-Inferior Iliac Spine)

18. Reinsertion of the tendon
(Avulsion from the Antero-Inferior Iliac Spine)

19. Muscle-tendon suture
Complete rupture of MTPJ

20. Muscle-tendon suture
Complete rupture of MTPJ

21. Muscle-tendon suture
Complete rupture of MTPJ

22. Complete rupture of MTPJ

23. Muscle-tendon suture
Complete rupture of MTPJ

24. Muscle-tendon suture
Complete rupture of MTPJ

25. Muscle-tendon suture
Complete rupture of MTPJ

26.  Subacute complete rupture with 2.5 cm retraction of the Right indirect
tendon
 Subacute complete rupture with retraction of the direct right tendon of 4.5
cm insertion in the anteroinferior iliac spine
Complete rupture of MTPJ

27. Muscle-tendon suture
Complete rupture of MTPJ

28. Muscle-tendon suture
Complete rupture of MTPJ

29. Muscle-tendon suture
Complete rupture of MTPJ

30. Muscle-tendon suture
Rupture of MTPJ & Cyst Cavity

31. Muscle-tendon suture
Rupture of MTPJ & Cyst Cavity

32. Muscle-tendon suture
Rupture of MTPJ & Cyst Cavity

33. Complete release, relaxation of the muscle belly & suture
Complete rupture MTDJ

34. Distal Injury: Quadriceps Tendon Rupture

35. Conclussions
Vaquerizo García V, Casa Duhrkop D, Seijas R, Ares O & Cugat R.
Surgical treatment of proximal ruptures of the Rectus Femoris in profesional
soccer players. Arch Orthop Trauma Surg. 132:329-33. 2012
doi:10.1007/s00402-011-1372-8

36. Conclussions
After surgery the return to sport is around 3-5
months
Symptoms and important signs to return to sport
Pain
Mobility
Ultrasound
Tensiomyography
Vaquerizo García V, Casa Duhrkop D, Seijas R, Ares O & Cugat R.
Surgical treatment of proximal ruptures of the Rectus Femoris in profesional
soccer players. Arch Orthop Trauma Surg. 132:329-33. 2012
doi:10.1007/s00402-011-1372-8

37. Thank you