title: Surgical Management of Rectus Femoris Avulsion Among Professional Soccer Players.
abstract: BACKGROUND
  Rectus femoris injuries are common among athletes, especially in kicking sports such as soccer; however, proximal rectus femoris avulsions in athletes are a relatively rare entity.
  
  
  OBJECTIVE
  The purpose of this study was to describe and report the results of an original technique of surgical excision of the proximal tendon remnant followed by a muscular suture repair. Our hypothesis was that this technique limits the risk of recurrence in high-level athletes and allows for rapid recovery without loss of quadriceps strength.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Our retrospective series included 5 players aged 31.8 ± 3.9 years with acute proximal rectus femoris avulsion injuries who underwent a surgical resection of the proximal tendon between March 2012 and June 2014. Four of these players had recurrent rectus femoris injuries in the 9 months before surgery, while 1 player had surgery after a first injury. Mean follow-up was 18.2 ± 12.6 months, and minimum follow-up was 9 months. We analyzed the age, sex distribution, physical examination outcomes, type and mechanism of injury, diagnosis, treatment and complications during surgery, postoperative follow-up, and time to return to play. The Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at 3-month follow-up, and isokinetic tests were performed before return to sports. A telephone interview was completed to determine the presence of recurrence at an average follow-up of 18.2 months.
  
  
  RESULTS
  At 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. Return to the previous level of play occurred at a mean of 15.8 ± 2.6 weeks after surgery, and none of the athletes suffered a recurrence. Isokinetic test results were comparable between both sides.
  
  
  CONCLUSIONS
  The surgical treatment of proximal rectus femoris avulsions, consisting of resection of the tendinous part of the muscle, is a reliable and safe technique allowing a fast recovery in professional athletes.
authors.affiliation: Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de sante, Hôpital privée jean Mermoz, Lyon, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sonnery-Cottet
authors.affiliation: Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de sante, Hôpital privée jean Mermoz, Lyon, France.
authors.forename: Nuno Camelo
authors.initials: NC
authors.lastname: Barbosa
authors.affiliation: Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de sante, Hôpital privée jean Mermoz, Lyon, France.
authors.forename: Sanesh
authors.initials: S
authors.lastname: Tuteja
authors.affiliation: Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de sante, Hôpital privée jean Mermoz, Lyon, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Gardon
authors.affiliation: Kansas City University, Kansas City, Missouri, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: Daggett
authors.affiliation: Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de sante, Hôpital privée jean Mermoz, Lyon, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Monnot
authors.affiliation: Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de sante, Hôpital privée jean Mermoz, Lyon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Kajetanek
authors.affiliation: Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de sante, Hôpital privée jean Mermoz, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Thaunat
keywords: proximal avulsion; quadriceps injuries; rectus femoris; surgical treatment