title: The association between avulsions of the reflected head of the rectus femoris and labral tears: a retrospective study.
abstract: BACKGROUND
  The aim of this study was to investigate if an association existed between the reflected head of rectus femoris avulsion injuries and labral tears in pediatric patients referred for magnetic resonance arthrography (MRA) or magnetic resonance imaging (MRI) evaluation.
  
  
  METHODS
  Electronic medical records of the patients between the ages of 12 and 18 who were treated at the hospitals affiliated by McMaster University between June 2000 and November 2010 with a diagnosis of rectus femoris avulsion injuries were retrospectively identified and analyzed. Patients were included if they had magnetic resonance imaging or MRA images of their hip.
  
  
  RESULTS
  Nine patients with avulsion injuries of the rectus femoris muscle were identified. The patient population consisted of 4 females and 5 males (range, 8 to 17 y, mean age 14 y). All injuries occurred during sports activity, which included running and kicking during soccer, skating in hockey, and a squatting exercise. MRA examination of 7 of these patients demonstrated associated labral tears. All patients were initially treated conservatively. Five patients continued to sustain from residual pain in the 9 months after the initial injury. Two of these patients with significant refractory pain were subsequently treated with hip arthroscopy. Intraoperatively, 1 small labral tear and 1 labral avulsion were identified and treated.
  
  
  CONCLUSIONS
  This study suggests that there may be an association between avulsion of the reflected head of rectus femoris and labral injuries and that there may be an underlying spectrum of traction injuries. Patients with rectus femoris avulsion injuries with persistent symptoms may be at risk for concurrent traumatic labral tears.
  
  
  METHODS
  Level 4, retrospective case series.
authors.affiliation: Departments of Orthopaedic Surgery, McMaster University Medical Centre, McMaster University, Hamilton, ON, Canada.
authors.forename: Clary J
authors.initials: CJ
authors.lastname: Foote
authors.forename: Zeev V
authors.initials: ZV
authors.lastname: Maizlin
authors.forename: Jason
authors.initials: J
authors.lastname: Shrouder
authors.forename: Mary M
authors.initials: MM
authors.lastname: Grant
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
mesh_terms: D000077:Acetabulum; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D025981:Hip Injuries / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D052097:Quadriceps Muscle / Q000293:injuries*; D012189:Retrospective Studies