Arthroscopy The Journal of Arthroscopic and Related Surgery 2012; 28:e359–60.
During 11 years (1997-2007) 23 patients with 24 rectus femoris muscle tears were treated surgically. There were 20 males and 3 females in the series. The mean age of the patients was 28 years (16-45 years). The right side was affected 15 times and the left side 9 times. In one patients both thighs were operated with the interval of two years. The sports events of the patients were: soccer 14, running events 3, orienteering 2, long jump 1 and judo 1. Two of the patients were not athletes. The site of injury was the distal third in 3 cases, medial third in 14 cases and proximal third 7 times. The trauma mechanism was in 10 cases sudden injury causing the tear, in 12 cases recurrent injuries lead to tear/scar/adhesions and in 2 cases relatively small trauma caused a “spontaneous” tear. In addition to clinical examination ultrasound echography was used 20 times and MRI 7 times. The indications for surgery were: loss of extension power, pain, cramps and weakness. In surgery there were total tear 16 times, subtotal tear with scarring 5 times and adhesions/scarring 3 times. The delay for surgery of the acute total tears was 3 months (1-10 months). It was possible to suture the muscle back in 7 cases and repair it with the help of the thickened fascias and scar tissue 9 times. Absorbable suture materials were used in most of the operations, nonabsorbable sutures only in 4 cases. In cases of recurrent tears the correction was done with plastic repair using the scarr tissue and compartement fascias on the sides, anteriorly and posteriorly in the rectus femoris muscle lodge. Sometimes Z-plasty of the central tendon was used or only excision of the adhesions and fasciotomy to maintain the normal muscle fuction. No postoperative plaster was ussed, cruthes were used from 3 to 7 days after surgery. Rehabilitation was started with isometric femoral settings and slowly increasing knee flexion angle, swimming, bicycling, gym training and jogging. The athletes were usually able to start running 2 months after surgery. More intensive sports performamces were allowed 3-4 months after surgery. In 2 patients wound healing complications occurred. They healed well with antibiotics. In three patients a postoperative hematoma appeared. In delayed healing, but did not cause later problem. In 2 cases (a soccer player and a non-athlete) reoperation was done appr. 6 months after the primary surgery.The follow-up of the patients was 2.5 years (8 months to 7 years).The results were good or excellent in 19 cases and moderate in 6 cases. Only 3 of the athletes did not return to the previous level of sports.