Proximal rectus femoris tendon avulsions (PRFA) are relatively rare injuries that occur predominantly among young soccer players. The aim of this study was to evaluate mid-term postoperative results including strength potential via standardized strength measurements after proximal rectus femoris tendon refixation. It was hypothesized that the majority of competitive athletes return to competition after refixation of the rectus femoris tendon without significant strength or functional deficits compared to the contralateral side.
Patients with an acute (< 6 weeks) proximal rectus femoris tendon avulsion (PRFA) who underwent surgical refixation between 2012 and 2019 with a minimum follow-up of 12 months were evaluated. Return to competition time frames and outcome measures by means of Harris Hip Score (HHS), Hip and Groin Outcome Score subscales (HAGOS), International Hip Outcome Tool-33 (iHOT-33), Visual Analog Scale (VAS), and median Tegner Activity Scale (TAS) were compiled. Additionally, a standardized isometric strength assessment of knee flexion, knee extension, and hip flexion and a single-leg hop for distance was performed to evaluate the functional result in comparison to the uninjured side.
A total of 16 patients were evaluated at a mean follow-up of 44.8 ± 28.9 months after surgery. All patients were male with 87.5% being injured while playing soccer. The average time interval between trauma and surgery was 18.4 ± 8.5 days. Return to competition was possible for 14 out of 15 previously competitive athletes (93.3%) at a mean of 10.5 ± 3.4 months after trauma. Patients achieved a high level of activity postoperatively with a median (interquartile range) TAS of 9 (7-9) and reported good to excellent outcome scores (HHS: 100 (96-100); HAGOS: Symptoms 94.6 (89.3-100), Pain 97.5 (92.5-100), Function in daily living 100 (95-100), Function in sport and recreation 98.4 (87.5-100), Participation in physical activities 100 (87.5-100), Quality of life 83.1 ± 15.6; iHot-33: 95.1 (81.6-99.8)). The majority of patients were "very satisfied" (56.3%) or "satisfied" (37.5%) with the postoperative result and reported little pain (VAS 0 (0-0.5)). No postoperative complications were reported. Range of motion, isometric knee flexion and extension, as well as hip flexion strength levels were not statistically different between the affected and contralateral legs.
Surgical treatment of acute PRFA yielded excellent postoperative results in a young and highly active cohort. Hip flexion and knee extension strength was restored fully without associated major surgical complications.