Proximal Rectus Femoris Avulsion: Ultrasonic Diagnosis and Nonoperative Management

Abstract

Objective: To present a case of ultrasonic diagnosis and nonoperative management of a complete proximal rectus femoris avulsion in a National Collegiate Athletic Association Division 1 soccer goalkeeper.

Background: While delivering a goal kick, a previously uninjured 24-year-old collegiate soccer goalkeeper had the sudden onset of right anterior thigh pain. He underwent rehabilitation with rapid resolution of his presenting pain but frequent intermittent recurrence of anterior thigh pain. After he was provided a definitive diagnosis with musculoskeletal ultrasound, he underwent an extended period of rehabilitation and eventually experienced complete recovery without recurrence.

Differential diagnosis: Rectus femoris avulsion, rectus femoris strain or partial tear, inguinal hernia, or acetabular labral tear.

Treatment: Operative and nonoperative options were discussed. In view of the player's recovery, nonoperative options were pursued with a good result.

Uniqueness: Complete proximal rectus femoris avulsions are rare. Our case contributes to the debate on whether elite-level kicking and running athletes can return to full on-field performance without surgery.

Conclusions: Complete proximal rectus femoris avulsions can be treated effectively using nonoperative measures with good preservation of function even in the elite-level athlete. In addition, musculoskeletal ultrasound is an excellent tool for on-site evaluation and may help guide prognosis and management.

Keywords: athletic injuries; rehabilitation; soccer.

Figure 1.

Photograph of the right thigh with a notable defect in the region of the rectus femoris during resisted hip flexion.

Figure 2.

Ultrasound images of the left (unaffected) and right (affected) rectus femoris. A, The normal rectus femoris structure at the anterior-inferior iliac spine and B, 10 cm distal in the midthigh. C, The remaining stump of the right rectus femoris and D, a region of scarring 10 cm distal.