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Afetse EK, Kanakamedala AC, Nishimura H, Jochl OM, Ruzbarsky JJ. Open Isolated Distal Rectus Tendon Repair. Arthrosc Tech 2024; 13:103004. [PMID: 39233811 PMCID: PMC11369942 DOI: 10.1016/j.eats.2024.103004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 09/06/2024] Open
Abstract
Isolated distal rectus femoris avulsions from the common quadriceps tendon are rare and may be missed due to the integrity of the remaining extensor mechanism. In healthy, active patients, surgical repair is recommended due to the potential for persistent pain, cramping, and weakness. In the case of isolated distal rectus femoris avulsions, however, there are important surgical considerations and differences when compared with the treatment of complete quadriceps tendon ruptures. This Technical Note describes an open repair of an isolated distal rectus femoris rupture with reinsertion into the common quadriceps tendon.
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Affiliation(s)
- Eddie K. Afetse
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | | | - Olivia M. Jochl
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Joseph J. Ruzbarsky
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
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Nishimura H, Yamaura K, Stetzelberger VM, Garcia AR, Brown JR, Hollenbeck JF, Mologne MS, Uchida S, Philippon MJ. Biomechanical Comparison Between Double-Row Repair and Soft Tissue Tenodesis for Treatment of Proximal Rectus Femoris Avulsions. Orthop J Sports Med 2024; 12:23259671231213864. [PMID: 38379581 PMCID: PMC10878231 DOI: 10.1177/23259671231213864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 02/22/2024] Open
Abstract
Background Some patients with proximal rectus femoris (PRF) avulsions require surgical treatment after failed nonoperative treatment. There is no consensus on the superiority of suture anchor repair with the suture-bridge repair (SBR) technique versus tenodesis repair (TR) for PRF avulsions. Purpose To compare the failure load and elongation at failure between SBR and TR and to compare the stiffness of these 2 repair techniques versus the native state. Study Design Controlled laboratory study. Methods Seven pairs of human cadaveric hemipelvises were dissected to the PRF and sartorius origins. Each specimen underwent preconditioning followed by a distraction test to determine the stiffness of the native specimen. One specimen of each pair received one of the repair methods (SBR or TR), while the other specimen in the pair received the other repair technique. After repair, each specimen underwent preconditioning followed by a pull to failure. The failure load, elongation at failure, stiffness, mode of failure, and stiffness as a percentage of the native state were determined for each repair. Results The SBR group exhibited a stronger failure load (223 ± 51 N vs 153 ± 32 N for the TR group; P = .0116) and significantly higher stiffness as a percentage from the native state (70.4% ± 19% vs 33.8% ± 15.5% for the TR group; P = .0085). While the stiffness of the repair state in the SBR group (41.5 ± 9.4 N/mm) was not significantly different from that of the native state (66.2 ± 36 N/mm), the stiffness of the repair state in the TR group (20.3 ± 7.5 N/mm) was significantly lower compared with that of the native state (65.4 ± 22.1 N/mm; P < .001) and repair state in the SBR group (41.5 ± 9.4 N/mm; P = .02). The SBR group primarily failed at the repair site (71%), and the TR group primarily failed at the suture-sartorius interface (43%) and at the muscle (29%). Conclusion SBR and TR specimens were significantly weaker than the native tendon. The stiffness of the SBR was equivalent to that of the native tendon, while TR was significantly less stiff than the native tendon. The SBR was superior to TR in terms of failure load, stiffness, and percentage stiffness from the native state. Clinical Relevance SBR may be a better surgical option than TR to optimize failure load and stiffness for PRF avulsions.
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Affiliation(s)
| | - Kohei Yamaura
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | | | | | | | - Soshi Uchida
- Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Marc J. Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Knapik DM, Alter TD, Ganapathy A, Smith MV, Brophy RH, Matava MJ. Isolated, Full-Thickness Proximal Rectus Femoris Injury in Competitive Athletes: A Systematic Review of Injury Characteristics and Return to Play. Orthop J Sports Med 2023; 11:23259671221144984. [PMID: 36743725 PMCID: PMC9893374 DOI: 10.1177/23259671221144984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023] Open
Abstract
Background Characteristics regarding mechanism of injury, management, and return-to-play (RTP) rate and timing are important when treating and counseling athletes with rectus femoris tears. Purpose To systematically review the literature to better understand the prevalence, sporting activity, injury mechanisms, and treatment of patients with rectus femoris injury and to provide prognostic information regarding the rate and timing of RTP. Study Design Systematic review; Level of evidence, 4. Methods Following the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we queried PubMed/MEDLINE, Cochrane, OVID, EMBASE, and Google Scholar in March 2022 for studies reporting on athletes sustaining isolated, full-thickness tearing, or bony avulsion injuries to the proximal rectus femoris during sporting activity. Excluded were studies without evidence of full-thickness tearing or avulsion, with athletes sustaining concomitant injuries, or with injuries occurring from nonsporting activities. The percentage of athletes sustaining injuries was calculated based on sport, injury mechanism, and management (nonoperative versus operative). Results Of 132 studies initially identified, 18 were included, comprising 132 athletes (mean age, 24.0 ± 5.4 years; range, 12-43 years). The most common sporting activities were soccer (70.5%) and rugby (15.2%). The most reported mechanisms of injury were kicking (47.6%) and excessive knee flexion/forced hip extension (42.9%). Avulsion injuries were reported in 86% (n = 114) of athletes. Nonoperative management was reported in 19.7% of athletes, with operative management performed in 80.3%. The mean follow-up time was 21.4 ± 11.4 months (range, 1.5-48 months). The RTP rate was 93.3% (n = 14) in nonoperatively treated and 100% (n = 106) in operatively treated athletes, and the mean RTP time was 11.7 weeks (range, 5.5-15.2 weeks) in nonoperatively treated and 22.1 weeks (range, 14.0-37.6 weeks) in operatively treated athletes. Complications were reported in 7.7% (2/26) of nonoperatively treated and 18% (n = 19/106) of operatively treated athletes. Conclusion Full-thickness proximal rectus femoris injuries occurred most frequently in athletes participating in soccer and rugby secondary to explosive, eccentric contractions involved in kicking and sprinting. Operative management was performed in the majority of cases. Athletes who underwent operative repair had a 100% RTP rate versus 93.3% in athletes treated nonoperatively.
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Affiliation(s)
- Derrick M. Knapik
- School of Medicine, Washington University in St Louis, St Louis,
Missouri, USA.,Department of Orthopaedic Surgery, Washington University in St
Louis, St Louis, Missouri, USA., Derrick M. Knapik, MD, Department of Orthopaedic Surgery,
Washington University, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO
63110, USA ()
| | - Thomas D. Alter
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,
USA
| | - Aravinda Ganapathy
- School of Medicine, Washington University in St Louis, St Louis,
Missouri, USA
| | - Matthew V. Smith
- School of Medicine, Washington University in St Louis, St Louis,
Missouri, USA.,Department of Orthopaedic Surgery, Washington University in St
Louis, St Louis, Missouri, USA
| | - Robert H. Brophy
- School of Medicine, Washington University in St Louis, St Louis,
Missouri, USA.,Department of Orthopaedic Surgery, Washington University in St
Louis, St Louis, Missouri, USA
| | - Matthew J. Matava
- School of Medicine, Washington University in St Louis, St Louis,
Missouri, USA.,Department of Orthopaedic Surgery, Washington University in St
Louis, St Louis, Missouri, USA
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Flores DV, Umpire DF, Sampaio ML, Cresswell ME, Pathria MN. US and MRI of Pelvic Tendon Anatomy and Pathologic Conditions. Radiographics 2022; 42:1433-1456. [PMID: 35960665 DOI: 10.1148/rg.220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The bony pelvis serves as the attachment site for a large number of powerful muscles and tendons that drive lower extremity movement. Organizing the pelvic tendons into groups that share a common function and anatomic location helps the radiologist systematically evaluate these structures for injury, which can be caused by repetitive stress, acute trauma, or failure of degenerated tissues. Tears of the anteromedial adductors around the pubic symphysis and anterior flexors traversing anterior to the hip principally affect younger male athletes. Tears of the lateral abductors and posterior extensors are more common in older individuals with senescent tendinosis. The deep external rotators are protected and rarely injured, although they can be impinged. Imaging of the pelvic tendons relies primarily on US and MRI; both provide high spatial and contrast resolution for soft tissues. US offers affordable point-of-care service and dynamic assessment, while MRI allows simultaneous osseous and articular evaluation and is less operator dependent. While the imaging findings of pelvic tendon injury mirror those at appendicular body sites, radiologists may be less familiar with tendon anatomy and pathologic conditions at the pelvis. The authors review pertinent anatomy and imaging considerations and illustrate common injuries affecting the pelvic tendons. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Dyan V Flores
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Marcos Loreto Sampaio
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mark Edward Cresswell
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mini N Pathria
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
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