Chronic and Recurrent Rectus Femoris Central Tendon Ruptures in Athletes: Clinical Picture, MRI Findings, and Results of Surgical Treatment

Background: Severe rectus femoris central tendon rupture is an uncommon sports-related injury. Most rectus femoris central tendon injuries can be treated by nonoperative means, but some tend to reinjure, resulting in chronic symptoms. Physicians treating athletes with rectus femoris injuries should be aware of this clinical condition and know that surgical treatment could be beneficial to the athlete if the rectus femoris central tendon rupture becomes chronic. Purpose: To describe the clinical picture, magnetic resonance imaging (MRI) findings, and surgical treatment results of rectus femoris central tendon injuries. Study Design: Case series; Level of evidence, 4. Methods: This study included 12 patients who underwent successful repair of recurrent rectus femoris central tendon rupture. Presurgical MRI scans were obtained and compared with the surgical findings. The time of return to play was recorded, and the outcome of surgical treatment was evaluated with validated Subjective Patient Outcome for Return to Sports (SPORTS) criteria: good = full return to preinjury level of sports without any symptoms; moderate = return to preinjury level of sports with some residual symptoms (mild discomfort during sports); and poor = did not return to preinjury level of sports. Results: Overall, 10 patients had a good outcome (83%), and 2 had a moderate outcome (17%). All athletes included in the study were able to return to sport at their preinjury levels 2.5 to 4 months postoperatively. Presurgical MRI scans correlated well with the surgical findings. Conclusion: The surgical treatment of rectus femoris central tendon rupture seems to be a good option in chronic and recurrent cases. After surgery and successful rehabilitation, the athlete is expected to continue sports at the preinjury level.

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Central Tendon Injuries of Hamstring Muscles: Case Series of Operative Treatment

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118755992 ◽

2018 ◽

Vol 6 (2) ◽

pp. 232596711875599 ◽

Cited By ~ 5

Author(s):

Lasse Lempainen ◽

Jussi Kosola ◽

Ricard Pruna ◽

Jordi Puigdellivol ◽

Janne Sarimo ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Surgical Treatment ◽

Magnetic Resonance ◽

Case Series ◽

Hamstring Tendon ◽

Tendon Injury ◽

Tendon Injuries ◽

Return To Play ◽

Resonance Imaging ◽

Hamstring Muscles

Background: As compared with injuries involving muscle only, those involving the central hamstring tendon have a worse prognosis. Limited information is available regarding the surgical treatment of central tendon injuries of the hamstrings. Purpose: To describe the operative treatment and outcomes of central tendon injuries of the hamstrings among athletes. Study Design: Case series; Level of evidence, 4. Methods: Eight athletes (6 top level, 2 recreational) with central hamstring tendon injuries underwent magnetic resonance imaging and surgical treatment. The indication for surgery was recurrent (n = 6) or acute (n = 2) central hamstring tendon injury. All patients followed the same postoperative rehabilitation protocol, and return to play was monitored. Results: Magnetic resonance imaging found a central tendon injury in all 3 hamstring muscles (long head of the biceps femoris, semimembranosus, and semitendinosus) with disrupted tendon ends. In acute and recurrent central tendon injuries, full return to play was achieved at 2.5 to 4 months. There were no adverse events during follow-up. Conclusion: Central tendon injuries of the hamstrings can be successfully repaired surgically after acute and recurrent ruptures.

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Surgical Management of Rectus Femoris Avulsion Among Professional Soccer Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967116683940 ◽

2017 ◽

Vol 5 (1) ◽

pp. 232596711668394 ◽

Cited By ~ 7

Author(s):

Bertrand Sonnery-Cottet ◽

Nuno Camelo Barbosa ◽

Sanesh Tuteja ◽

Roland Gardon ◽

Matt Daggett ◽

...

Keyword(s):

Case Series ◽

Rectus Femoris ◽

Quadriceps Strength ◽

Return To Play ◽

Suture Repair ◽

Return To Sports ◽

Level Of Evidence ◽

Professional Soccer ◽

Isokinetic Test

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. Purpose/Hypothesis: 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. Study Design: 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. Conclusion: 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.

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Muscle Strains in the Lower Extremity of Japanese Professional Baseball Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120956569 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095656

Author(s):

Takeshi Kokubu ◽

Yutaka Mifune ◽

Noriyuki Kanzaki ◽

Yuichi Hoshino ◽

Kenichiro Kakutani ◽

...

Keyword(s):

Lower Extremity ◽

High Intensity ◽

Case Series ◽

Return To Play ◽

Professional Baseball ◽

Mri Findings ◽

Level Of Evidence ◽

Baseball Players ◽

Musculotendinous Junction ◽

Lower Extremity Muscle

Background: Predicting when athletes can return to play after muscle strains is not always simple because of difficulties in evaluating the severity of such injuries. Purpose/Hypothesis: The purpose of this study was to evaluate the use of magnetic resonance imaging (MRI) to classify lower extremity muscle strains in Japanese professional baseball players. The hypothesis was that MRI grading can be used to diagnose the severity of muscle strains in the lower extremity and predict return to play in athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 55 muscle strains occurred in the lower extremity of players on a professional baseball team between the 2006 and 2015 seasons; all players had undergone MRI examination. Age, player position, location of injury, cause of injury, and duration until return to play (in days) were extracted from the medical records. MRI scans were classified using the following system: grade 0, no abnormal findings; grade 1a, T2-weighted high intensity only between muscles; grade 1b, T2-weighted high intensity between muscles and in muscle belly; grade 2, injury of musculotendinous junction; and grade 3, rupture of tendon insertion. Results: The sites of injuries were distributed as follows: hamstrings (n = 33), quadriceps (n = 6), hip adductors (n = 6), and calves (n = 10). MRI findings revealed 9 muscle strains (16%), 19 grade 1a (34%), 19 grade 1b (34%), and 8 grade 2 muscle strains (16%). The length of time until return to training and competition, respectively, was 15 and 26 days for grade 1a injuries, 19 and 36 days for grade 1b injuries, and 55 and 69 days for grade 2 injuries. Conclusion: Players with grade 1 injuries took 4 to 5 weeks to return to play, whereas players with grade 2 injuries took 10 weeks to return. MRI can be useful for diagnosing lower extremity muscle strains and predicting the time to return to play.

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Lesão SLAP Tipo II Isolada em Desportistas – Reparação Labral ou Tenodese da Longa Porção do Bicípite. Análise de Resultados e Taxa de Return to Play

10.23911/lesao_slap_cirurgia_2021_mai ◽

2021 ◽

Vol 12 (3) ◽

pp. 27-30

Author(s):

André Barros ◽

◽

Sérgio Gonçalves ◽

Eduardo Carpinteiro ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Techniques ◽

Clinical Results ◽

Return To Play ◽

Rate Of Return ◽

Labral Repair ◽

Return To Sports ◽

Sports Activity ◽

Previous Level ◽

The Mean

Introduction: SLAP injuries are common in young athletes and in the military men. In the failure of conservative treatment, surgical treatment is indicated. Objectives: To compare clinical results in two groups of sportsmen and military men with SLAP type II injuries who underwent two surgical techniques. Material and methods: Retrospective study, in sportsmen and military personnel submitted to surgical treatment between 2010 and 2018. Each group was submitted to the same technique by the same surgical team. Clinical evaluation was performed with a Constant (SC) score, complications were recorded, surgical re-interventions, rate of return to sports activity and rate of return to the previous level of activity. Results: We analyzed 25 patients, 12 who underwent labral repair (RL) and 13 who underwent bicipital tendon tenodesis (TLPB). The mean follow-up was 4.5 years, the mean age was 25.7 years for the RL group and 31 years for the TLPB group. There was an improvement in SC in both groups. In the RL, there were 4 cases of post-operative stiffness with two re-interventions, whereas with the TLPB there was a failure with tenodesis rupture. The rate of return to sports activity was 100% in both groups, but in the RL group the rate of return to the previous level was 42% and in the TLPB group 70%. Conclusions: Both techniques have good clinical results in the medium and long term. In our series, the results are superior for TLPB and without re-interventions. In the RL group, the rate of complications was higher and the rate of return to the previous level of sports activity was lower.

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Surgical Treatment of Chronic Patellar Tendon Rupture: A Case Series Study

Trauma Monthly ◽

10.5812/traumamon.59259 ◽

2018 ◽

Vol 23 (2) ◽

Author(s):

Mahmoud Jabalameli ◽

Abolfazl Bagherifard ◽

Hosseinali Hadi ◽

Mohammad Mujeb Mohseni ◽

Amin Yoosefzadeh ◽

...

Keyword(s):

Surgical Treatment ◽

Patellar Tendon ◽

Tendon Rupture ◽

Case Series ◽

Patellar Tendon Rupture ◽

Case Series Study ◽

Series Study

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Peroneal Tendoscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00215 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0021

Author(s):

İsmail Ayder Gülten ◽

Mustafa Ürgüden ◽

Hakan Bilbaşar ◽

Fikri Feyyaz Akyıldız

Keyword(s):

Tendon Rupture ◽

Excision Repair ◽

Osteochondral Lesions ◽

Peroneal Tendon ◽

Mri Findings ◽

Ankle Joints ◽

Mri Scans ◽

Physical Examinations ◽

Peroneus Brevis ◽

Tendon Pathology

Objectives: Peroneal tendon pathology should be within the differential diagnoses of patients who are admitted to the hospital with posterolateral ankle pain. Peroneal tendoscopy is a minimally invasive choice for the diagnosis and the treatment of peroneal tendon pathologies. Aim of this study is to discuss the role of tendoscopy within the diagnosis and the treatment of peroneal tendon pathologies. Methods: From 2006 to 2012, 18 patients with retrofibular pain are included in this study. This study had been planned prospectively. For the patients who had been pre-diagnosed as ‘’ peroneal tendinopathy’’ with physical examination, X-ray and MRI findings, ‘’peroneal tendoscopy’’had been performed diagnostically. After diagnostic peroneal tendoscopy, patients were definitively treated either with tendoscopy or with open surgery. Results: We have included 18 patients with retrofibular pain, 13 were female and 5 were male. The mean age was 46.8 (29-71). Preoperatively taken MRI scans showed talar osteochondral lesions (TOL) in 8 patients, peroneal tenosynovitis in 8 patients (3 of them were with TOL), suspected peroneal tendon rupture in 3 patients (2 of them were with TOL, accessory peroneal tendon in 1 patient). MRI scans of 5 patients were normal regarding peroneal pathology, these patients were operated according to physical examinations and the findings. 13 of 18 patients had accompanying anterior and posterior ankle pathologies. The most common pathology which had been detected in 8 patients with retrofibular pain was talar ostechondral lesion (TOL). The other 5 patients had no concomitant pathology. During peroneal tendoscopy, accessory peroneal tendon in 6 patients and distal insertion of peroneus brevis tendon in 3 patients had been detected and excised minimally invasively. In 4 patients, peroneal tendon rupture had been detected and excision/repair/tenodesis had been performed, in 3 patients tenosynovectomy had been performed for peroneal tenosynovitis, duplication had been performed in 1 patient, tubulisation had been performed in 1 patient and vincula excision had been performed in 1 patient. Conclusion: Peroneal tendoscopy is a useful procedure to diagnose and to treat the pathology of peroneal tendons. According to our theory, patients could have a sensation of fullness within their ankle joints with the presence of accessory muscle and distal insertion of peroneus brevis tendon within the superior peroneal retinaculum and may put their ankle in slight inversion position. This positional change within the ankle may disturb the ankle biomechanics and may be one of the causes of osteochondral lesions of the talus.

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Acromioclavicular Joint Injuries in Professional Ice Hockey Players: Epidemiologic and MRI Findings and Association With Return to Play

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120964474 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096447

Author(s):

Lawrence M. White ◽

Jonathan Ehmann ◽

Robert R. Bleakney ◽

Anthony M. Griffin ◽

John Theodoropoulos

Keyword(s):

Acromioclavicular Joint ◽

Ice Hockey ◽

Return To Play ◽

Low Grade ◽

Mri Findings ◽

Grade 5 ◽

Significant Difference ◽

Hockey Players ◽

Mri Scans ◽

Grade 3

Background: Acromioclavicular joint (ACJ) injuries are common in ice hockey players and are traditionally evaluated with conventional radiography, which has recognized limitations in the accurate characterization of the spectrum of soft tissue injuries and severity/grade of injury sustained. Purpose: To evaluate the epidemiologic, clinical, and magnetic resonance imaging (MRI) findings in professional ice hockey players who have sustained acute ACJ injuries. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of professional National Hockey League (NHL) players referred for MRI evaluation of acute ACJ injuries. All MRI scans were assessed for status of the ACJ, ligamentous stabilizers, and surrounding musculature. MRI-based overall grade of ACJ injury (modified Rockwood grade 1-6) was assigned to each case. Data regarding mechanism of injury, player handedness, clinical features, and return to play were evaluated. Results: Overall, 24 MRI examinations of acute ACJ injuries (23 patients; mean age, 24 years) were reviewed. We found that 50% of injuries were sustained during the first period of play, and in 75% of cases, injuries involved the same side as player shooting handedness. Analysis of MRI scans revealed 29% (7/24) grade 1 ACJ injuries, 46% (11/24) grade 2 injuries, 21% (5/24) grade 3 injuries, and 4% (1/24) grade 5 injuries. Trapezius muscle strains were seen in 79% and deltoid muscle strain in 50% of cases. Nonoperative management was used for 23 injuries; 1 patient (grade 5 injury) underwent acute reconstructive surgery. All players successfully returned to professional NHL competition. Excluding cases with additional injuries or surgery (n = 3) or convalescence extending into the offseason (n = 3), we found that the mean return to play was 21.4 days (7.2 games missed). No statistically significant difference was observed in return to play between nonoperatively treated grade 3 injuries (mean, 28.3 days) and grade 1 or 2 injuries (mean, 20.1 days). However, grade 3 injuries were associated with a greater number of NHL scheduled games missed (mean, 12.7) compared with lower grade injuries (mean, 6.1) ( P = .027). Conclusion: The spectrum of pathology and grading of acute ACJ injuries sustained in professional ice hockey can be accurately assessed with MRI; the majority of injuries observed in this study were low grade (grades 1 and 2). Although grade 3 injuries were associated with a greater number of games missed, similar return-to-play results were observed between nonoperatively treated grade 3 and grade 1 or 2 ACJ injuries.

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Case Series of First Metatarsophalangeal Joint Injuries in Division 1 College Athletes

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738114527546 ◽

2014 ◽

Vol 6 (6) ◽

pp. 519-526 ◽

Cited By ~ 12

Author(s):

John Faltus ◽

Kerry Mullenix ◽

Claude T. Moorman ◽

Kyle Beatty ◽

Mark E. Easley

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Medical Information ◽

Case Series ◽

Return To Play ◽

Team Approach ◽

Return To Sports ◽

First Metatarsophalangeal Joint ◽

Athletic Population ◽

Plantar Plate

Context: Injuries of the first metatarsophalangeal (hallux MP) joint can be debilitating in the athletic population. Turf toe and plantar plate injuries are typically diagnosed similarly. However, variance in injury mechanism as well as compromised integrity of soft tissue and ligamentous structures make it difficult to accurately diagnose specific hallux MP injuries. Recent literature has supported the use of both radiographic imaging and the Lachman test as reliable indicators of joint instability in the presence of hallux MP injuries. To date, research supporting specific rehabilitation interventions and return-to-play decision making for hallux MP injuries has been limited to case studies and suggested guidelines from literature reviews. There is limited evidence suggesting specific criteria for surgical and nonsurgical decision making in conjunction with rehabilitation progressions to return an athlete to sport when managing hallux MP injuries. Evidence Acquisition: A literature search was performed using Medline, PubMed, and Google Scholar to find and review articles from 1970 to 2013 that addressed the basic anatomy of the plantar plate, injuries to this anatomical structure, and the evaluation, diagnosis, surgical and nonsurgical management, and rehabilitation of these injuries, specifically in the athletic population. Medical information for each case was gathered from electronic medical records from the individual athletes cited in this case series, which included imaging reports, rehabilitation documentation, and both evaluation and surgical reports. No statistical analysis was used. Study Design: Case series. Level of Evidence: Level 4. Results: Treatment plans for each case varied depending on surgical and nonsurgical intervention and rehabilitation outcomes. However, each athlete was able to return to sports-specific activities. Conclusion: Successful outcomes for hallux MP injuries are contingent on thorough evaluation, appropriate clinical decision making with regard to surgical versus nonsurgical treatment planning, and a multidisciplinary team approach for ensuring a safe return to sport. Strength-of-Recommendation Taxonomy (SORT): C.

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Fifth Metatarsal Fractures in Professional Soccer Players: Case Series

Foot & Ankle Specialist ◽

10.1177/1938640020911223 ◽

2020 ◽

pp. 193864002091122

Author(s):

Tiago Baumfeld ◽

Ricardo Fernandes Rezende ◽

Caio Nery ◽

Jorge P. Batista ◽

Daniel Baumfeld

Keyword(s):

Surgical Treatment ◽

Fracture Healing ◽

Case Series ◽

Clinical Results ◽

Soccer Players ◽

Return To Sports ◽

Professional Soccer ◽

Before And After ◽

Metatarsal Fractures ◽

Vas Scores

Objective. Fifth metatarsal fractures occur mainly in young athletes, with an estimated incidence of 1.8 per 1000 individuals per year. This study aims to evaluate the functional outcome of professional soccer players undergoing surgical treatment of fifth metatarsal base fractures. Methods. We appraised 34 soccer players operated on from July 2001 to June 2016. All individuals were assessed by the American Orthopedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) before and after surgery, with a mean 23-month follow-up. The need for grafting, fracture healing, Torg classification, and return to sports were also evaluated. Results. There were 10 attackers, 7 offensive-defensive midfielders, 6 side defenders, 5 central defensive midfielders, 3 defenders, 2 goalkeepers, and 1 defensive midfielder, at an average age of 19 years. Preoperative and postoperative AOFAS averaged 42 and 99 points, respectively, whereas VAS scores were 6 and 0. The longer the time to get operated on, the greater was the need for grafting (P = .011). In our study, all fractures have consolidated. Return to sports occurred, on average, 73 days after surgical treatment, and it was not influenced by the time to get operated on, fracture healing, Torg classification, and grafting. Conclusion. Surgical treatment of the fifth metatarsal base fracture in professional soccer players presents good clinical results. Getting back to activities after surgery is not influenced by surgery time, fracture healing, Torg classification, and grafting. Levels of Evidence: Level IV: Therapeutic studies, Case series

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Outcomes of Surgical Treatment for Anterior Tibial Stress Fractures in Athletes: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546517741137 ◽

2018 ◽

Vol 47 (1) ◽

pp. 232-240 ◽

Cited By ~ 2

Author(s):

Zaira S. Chaudhry ◽

Steven M. Raikin ◽

Marc I. Harwood ◽

Meghan E. Bishop ◽

Michael G. Ciccotti ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Complication Rate ◽

Surgical Outcomes ◽

High Performance ◽

Stress Fractures ◽

Return To Play ◽

Return To Sports ◽

Symptom Resolution ◽

Anterior Tibial

Background: Although most anterior tibial stress fractures heal with nonoperative treatment, some may require surgical management. To our knowledge, no systematic review has been conducted regarding surgical treatment strategies for the management of chronic anterior tibial stress fractures from which general conclusions can be drawn regarding optimal treatment in high-performance athletes. Purpose: This systematic review was conducted to evaluate the surgical outcomes of anterior tibial stress fractures in high-performance athletes. Study Design: Systematic review; Level of evidence, 4. Methods: In February 2017, a systematic review of the PubMed, MEDLINE, Cochrane, SPORTDiscus, and CINAHL databases was performed to identify studies that reported surgical outcomes for anterior tibial stress fractures. Articles meeting the inclusion criteria were screened, and reported outcome measures were documented. Results: A total of 12 studies, published between 1984 and 2015, reporting outcomes for the surgical treatment of anterior tibial stress fractures were included in this review. All studies were retrospective case series. Collectively, surgical outcomes for 115 patients (74 males; 41 females) with 123 fractures were evaluated in this review. The overall mean follow-up was 23.3 months. The most common surgical treatment method reported in the literature was compression plating (n = 52) followed by drilling (n = 33). Symptom resolution was achieved in 108 of 123 surgically treated fractures (87.8%). There were 32 reports of complications, resulting in an overall complication rate of 27.8%. Subsequent tibial fractures were reported in 8 patients (7.0%). Moreover, a total of 17 patients (14.8%) underwent a subsequent procedure after their initial surgery. Following surgical treatment for anterior tibial stress fracture, 94.7% of patients were able to return to sports. Conclusion: The available literature indicates that surgical treatment of anterior tibial stress fractures is associated with a high rate of symptom resolution and return to play in athletes, although the high complication rate and potential need for subsequent procedures are important considerations for surgeons and patients.

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