Rectus Femoris Injuries: what and when? Sakari Orava 8th MuscleTech Network Workshop

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SURGERY FOR RECTUSSURGERY FOR RECTUS
FEMORIS MUSCLE AVULSIONSFEMORIS MUSCLE AVULSIONS
AND TEARSAND TEARS
NEO Hospital and Sports TraumaNEO Hospital and Sports Trauma
Research Center, TURKU,Research Center, TURKU,
FINLANDFINLAND

2. Retus femoris muscle tearsRetus femoris muscle tears
Conservative treatment usually, healing goodConservative treatment usually, healing good
In spite of defect the strength is maintainedIn spite of defect the strength is maintained
Rehabilitation may be longRehabilitation may be long
Some tears cause: pain, weakness, defect,Some tears cause: pain, weakness, defect,
cramps, recurrent small tears, scarring, adhesionscramps, recurrent small tears, scarring, adhesions
Surgical treatment necessary in selected casesSurgical treatment necessary in selected cases
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Rectus femoris muscle anatomyRectus femoris muscle anatomy

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Sites of tearSites of tear

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Patients with rectus femorisPatients with rectus femoris
muscle tearsmuscle tears
During 16 years (1997 – 2016) 32 pts/ 33 rectusDuring 16 years (1997 – 2016) 32 pts/ 33 rectus
femoris muscle mass tears treated surgicallyfemoris muscle mass tears treated surgically
Mean age 26 years (range 14 to 45 years)Mean age 26 years (range 14 to 45 years)
Men 29, women 4Men 29, women 4
Right side 20, left 13Right side 20, left 13
Sports: soccer 18, running 5, orienteering 3, longSports: soccer 18, running 5, orienteering 3, long
jump 1, judo 1, ice-hockey 1, recreationaljump 1, judo 1, ice-hockey 1, recreational
running 4running 4

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Examinations, indications forExaminations, indications for
surgery, type of lesionsurgery, type of lesion
Ultrasound echography 23, MRI 14Ultrasound echography 23, MRI 14
Indication for surgery: loss of extensionIndication for surgery: loss of extension
strength, pain, weakness, not able to full training,strength, pain, weakness, not able to full training,
recurrent new tearsrecurrent new tears
Total tear 23 cases, subtotal (elongation) 5,Total tear 23 cases, subtotal (elongation) 5,
scarring / seroma 5scarring / seroma 5
Delay of surgery 3 months (from 1 to 10)Delay of surgery 3 months (from 1 to 10)

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Surgical techniques, resultsSurgical techniques, results
- Fasciotomy, fasciectomy: all- Fasciotomy, fasciectomy: all
- Direct suturation 18- Direct suturation 18
- Augmentation with fascia- Augmentation with fascia
and sutures 16and sutures 16
- Central tendon Z-plasty 4- Central tendon Z-plasty 4
suturation 2suturation 2

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19. RehabilitationRehabilitation
 Walking with crutches with only 20-30 degrees knee flexion for 3Walking with crutches with only 20-30 degrees knee flexion for 3
weeksweeks
 Without crutches, full weight bearing, flexion up to 60-70Without crutches, full weight bearing, flexion up to 60-70
degrees during 3 following weeksdegrees during 3 following weeks
 Isometric thigh muscle settings as early as possibleIsometric thigh muscle settings as early as possible
 Flexion of knee more than 90 degrees 6 weeks after surgeryFlexion of knee more than 90 degrees 6 weeks after surgery
 Dynamic, concentric exercises gradually more each week,Dynamic, concentric exercises gradually more each week,
eccentric only 3 monhs after surgeryeccentric only 3 monhs after surgery
 Gym: 6 weeks, pool: 6 weeks, bicycle 2 monhs, jogging 3Gym: 6 weeks, pool: 6 weeks, bicycle 2 monhs, jogging 3
months, squatting with weights 4-5 monthsmonths, squatting with weights 4-5 months
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Follow-up, results, complicationsFollow-up, results, complications
Follow-up:Follow-up: 2.5 years (range 8 mo to 8 years)2.5 years (range 8 mo to 8 years)
RESULTSRESULTS: good / excellent 25: good / excellent 25
moderate 8moderate 8
COMPLICATIOSCOMPLICATIOS: 7, 1 superf. infection, 1: 7, 1 superf. infection, 1
partial wound opening, 3 superficialpartial wound opening, 3 superficial
hematomas, no effect to the final resulthematomas, no effect to the final result
In 2 pts rerupture, 1 total operated again, 1In 2 pts rerupture, 1 total operated again, 1
partial healed well with scarring: end resultspartial healed well with scarring: end results
goodgood

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Take home messageTake home message
Rectus femoris tears sometimes causeRectus femoris tears sometimes cause
remarcable pain, weakness and hamper sportsremarcable pain, weakness and hamper sports
With prompt diagnosis and close follow-upWith prompt diagnosis and close follow-up
cases needing early surgery are foundcases needing early surgery are found
Surgery demanding in chronic casesSurgery demanding in chronic cases
Results goodResults good