title: Endoscopic Extra-articular Surgical Removal of Heterotopic Ossification of the Rectus Femoris Tendon in a Series of Athletes.
abstract: BACKGROUND
  Calcific deposits in tendon, muscles, and periarticular areas are very common. Heterotopic ossification of the rectus femoris (HORF) is a rare condition, and several theories exist regarding the etiopathogenesis, which appears to be multifactorial with traumatic, genetic, and local metabolic factors involved. Although HORF typically responds to nonoperative treatment, when this approach fails, endoscopic treatment is a minimally invasive technique to address the pathology.
  
  
  OBJECTIVE
  To report the clinical and radiological outcomes of 9 athletes with HORF who underwent endoscopic resection.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Nine male athletes were treated with endoscopic extra-articular resection of HORF after failure of a 6-month course of nonoperative treatment. All patients were studied with radiographs, computed tomography, and magnetic resonance imaging. Outcomes were assessed clinically using the modified Harris Hip Score (mHHS), a visual analog scale for sport activity-related pain (VAS-SRP), patient satisfaction, and ability and time to return to the preoperative sport level. Radiographic assessment was performed to determine recurrence.
  
  
  RESULTS
  The mean age of the patients was 32 years (range, 23-47 years). Mean follow-up was 44 months (range, 14-73 months). All patients had improved mHHS scores from a mean preoperative of 65.6 (SD, 8.2) to 93.9 (SD, 3.6). Pain decreased from a mean 8.2 preoperatively (SD, 0.9) to 0.4 (SD, 0.7) at last follow-up. There were no complications, and all patients were able to return to their previous sports at the same level except for 1 recreational athlete. There was only 1 radiological recurrence at last follow-up in an asymptomatic patient.
  
  
  CONCLUSIONS
  To our knowledge, this is the largest case series of athletes with HORF treated with endoscopic resection. We found this extra-articular endoscopic technique to be safe and effective, showing clinical outcome improvement and 90% chance of return to full activity. We also found 10% recurrence rate of asymptomatic heterotopic ossification.
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Comba
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Nicolás S
authors.initials: NS
authors.lastname: Piuzzi
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Oñativia
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Zanotti
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Martín
authors.initials: M
authors.lastname: Buttaro
authors.affiliation: Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Francisco
authors.initials: F
authors.lastname: Piccaluga
keywords: arthroscopy; heterotopic ossification; hip; rectus femoris