A Rare Form of Soccer Injury – Rectus Femoris Tendon Rupture
Rectus Femoris Tendon Rupture
A rectus femoris rupture is the full or partial rupture of the upper part of the the thin muscle that goes from the front side of the hip to the knee. The main causes of rectus femoris ruptures are explosive kicking techniques.
The rectus femoris muscle is composed of fibers appropriate for rapid, forceful activity and crosses two joints (the hip and the knee). These characteristics may explain why this muscle is particularly vulnerable to eccentric stress forces, such as those resulting from the powerful contractions associated with sprinting and jumping. Soccer and rugby are the sports most commonly associated with injury to this muscle.
Rectus Femoris Muscle
Symptoms include:
- A sudden sharp pain at the front of the hip / in the groin usually whilst doing some explosive activity e.g. shooting practice.
- Swelling and bruising may occur.
- Pain in lifting the knee up against resistance.
- Pain when pressing in at the point of injury.
- If it is a total rupture then it will be impossible to contract the muscle. A lump may be felt due to recoil and bundling up of the proximal muscle.
Case Study
This is a 17-year old boy who is a football player. He was doing shooting practice when he felt a sudden acute pain in the front of his left thigh together with a pop sound.
Note the dimple seen due to tendon tear with muscle proximal retraction.
Rectus Femoris Rupture | HC Chang Orthopaedic Surgery
There is an obvious deformity in the thigh when he is asked to contract the muscle.
- Rectus Femoris Rupture | HC Chang Orthopaedic Surgery
MRI scan of the left thigh was done.
It showed a complete rupture of the rectus femoris tendon with proximal retraction.
Rectus Femoris Rupture MRI | HC Chang Orthopaedic Surgery
Rectus Femoris Rupture MRI Transverse
As this was a complete tear, surgery was deemed necessary in order to reattach the torn tendon.
Intra-operatively the torn tendon and muscle can be seen.
Rectus Femoris Rupture Intra-op
The tendon was reattached distally to the quadriceps tendon.
Repair of Rectus Femoris Rupture
The patient’s left knee was kept in full extension using a knee brace and he was not allowed to place weight on his left leg when walking using crutches for the next 6 weeks.
He was subsequently sent for physiotherapy after 6 weeks of protection of the repaired tendon.
He will need at least 4 to 6 months of rehabilitation before he can return to football training.
For more information on rectus femoris tendon ruptures or musculoskeletal problems, please email us at hcchang@ortho.com.sg or call us at +65-683 666 36.
HC Chang Orthopaedic Surgery | Singapore 
I ruptured my rectus formis tendon just over 2 years ago. At the time I went to three orthopedic doctors and none had dealt with this type of injury. They told me I could probably get by without the surgery because I still have full control of my leg and can bend it against pressure.
The injury occured during a soccer game when I was taking a shot on goal. I did some phyical therapy to strengthen the other muscles in my leg so I could continue playing soccer and other sports at the level I was accustomed to. about 6 months past and I decided I was not happy with the performance of my leg and went back to one of the doctors. He told me it was now too late to do the surgery.
My question to you, as you are a person who has actually performed thsi surgery, can I still have this surgery done? I understand the muscle is now coiled up near the top of my thigh and would be hard to pull down, but is it possible?
If it is possible, is there a chance my leg could perform better and be stronger than it is with out the surgery?
Thanks,
Sean
Sean,
I landed on this website after googling “rectus femoris rupture” and now read your comment posted only two days ago.
I sustained a soccer injury in late 2008 very similar to the one you describe above. However, because I was moving around the world, I did not have time to properly attend to my injury until this year.
I recently returned home for a new position and had a MRI taken in March of this year. The findings of the MRI point to a full rupture of the rectus femoris. I’m currently on the waiting list for a surgeon to see if surgery can still be performed.
There appears to be at least one successful case of late repair of a rectus femoris rupture on the internet: http://bjsm.bmj.com/content/37/2/182.full
If you have been able to find any other ressources online or elsewhere, it would be nice to share ressources. My email address is: vahan.pb@gmail.com
Cheers, and good luck,
Vahan
Sean,
Were you ever able to receive information regarding your question as to whether your leg could perform better and be stronger than it is without surgery?
Thanks,
Jack
Hi Sean
I wanted to get in touch regarding this injury. I have the exact same one (just happened 2 weeks ago). I have a rupture of the Rectus Femoris Muscle that is a complete rupture, not a partial. This tear happened at the musculotendinous junction. My rupture is at the transition between the muscle and tendon. No ligament is involved.
Would you recommend surgery based on your experience? Did you get surgery?
thx,
Nate
Hi, I have just been through surgery for a similar injury. It was diagnosed on the 27th December 2012 and I was operated on the 28th by Mr George at Poole General hospital. I sustained the original injury on the 12th after slipping on black ice and landing with full weight on my left leg, rupturing the muscle. I have had my leg in a back plate for 2weeks and now it has been put in a brace. My question would be why did the footballer have his leg set for 6 weeks?
His knee was not placed in any plaster. He was braced from the moment he left the operating room and the knee brace flexion was gradually increased over time.
This would be a good study for comparison as I am a 55 year old fitness fanatic. Mr George took some very good photographs during the procedure of the leg cavity, upper and lower muscle socks and the re-joined muscle saddle.
Great stuff. I have a video of my patient post-surgery doing single leg squats. Will post the video one of these days….
Hi Amedieo
I wanted to get in touch regarding this injury. I have the exact same one (just happened 2 weeks ago). I have a rupture of the Rectus Femoris Muscle that is a complete rupture, not a partial. This tear happened at the musculotendinous junction. My rupture is at the transition between the muscle and tendon. No ligament is involved.
Would you recommend surgery based on your experience? Did you get surgery?
thx,
Nate
i had the same injury about 5 months ago playing base ball runnig from 1st base to 2nd base when i heard a loud pop thinking i was hit with the ball but it was my thigh muscle that snapped – the dr. i went to said that it was a complete tear and that surgery wasnt needed as the other leg muscles would compensate- i had discomfort for about 10 days non stop day and night similar to a leg burn from climbing serveral flights of stairs at a rapid pace- i do have a very noticable lump on my right thigh that i was told will always be there. is there anything you recomend i do to reduce the tennis ball size lump? i have no pain what so ever now and i can still run but affraid of funning at full capacity.
You can’t reduce the lump on the front of your thigh. I would have operated and repaired the muscle/tendon back to the insertion.
If you read the comments in this post, a lot of people with similar injuries complain of pain, fatigue, weakness in the chronic stage.
I would go back and insist that they operate. It is a falsity for them to say that you will be ok without the muscle repaired and that other quads will compensate. In fact the psychological impact of the injury for me was more difficult to deal with than the physical impact as you are left wondering what your active lifestyle will become. I have no doubt that I would not have been able to continue to do the range of sports to the level that I was committed to. I am now going through my rehab at the Anglo-european Chiropractic clinic here in Bournemouth, where they scan my injury frequently and give me a tough rehab course. I see progress continually and it gives me confidence in an almost complete recovery. Something you will not experience unless the injury is repaired. Don’t accept second best and take Dr Chang Haw Chong’s advice, get it seen to as soon as possible.
Im guessing all of these injuries occurred at the tendon? My husband’s injury is described on the MRI report as “complete tear of the distal rectus femoris muscle” His doctor says he’s never seen anything like it before since most of these injuries occur lower at the tendon, where his occurred high in the muscle only. I cannot find anything at all online about this. Any suggestions?
Hi Gina,
Those that are torn at the junction between muscle and tendon (musculotendinous junction) or at the distal tendon can be repaired. Those that are purely muscle in nature and not retracted probably can heal without intervention.
Regards,
hc
Dr Chang im pretty sure i have this i got it from kicking the soccer ball.When i first started playing i had alot of pain on my right upper thigh every time i kicked the ball for around 10 days and i got a lump on my upper thigh exactly like the one in the picture.The pain went away this was like 7 years ago is it to late to get surgery.It hasnt affected my performance at all and i can run full speed just fine
Dear Onassis,
Yes, it is too late to do surgery as it has been 7 years ago since you sustained the injury. It will be near impossible to find the tear and bring it down to the actual place and to stitch it.
Regards,
hc
Hi Dr chang ,
I am simalar to one of the other comments i was playing football ( soccer ) and was shooting at goal when i felt it mine go however adrenaline was going and i continued to play , I went to physio and was told it could be a dead leg and the blood needed broken up , Now 2 months have past and the lump is still there but the pain only occurs when i try and kick a ball or put force on it , By the sounds of this could i avoid Surgery ? Im booked in for Friday to be seen and am just trying to figure out quick information . Thanks
I would suggest surgery.
The chance of a good result is better with surgery.
I wish u a speedy recovery!
saw a patient in the office yesterday with a chronic 12 month history of distal rectus tear.
Mri not significant atrophy?
thoughts on operative repair
Hi paul,
I would be very hesitant to offer surgical repair as the muscle would be contracted and it not reducible to the distal insertion site.
Is your patient symptomatic?
Hc
I received this injury in mid. Oct. finally went to the Dr. after 6 weeks. Is three months too late for successful surgery?
Hi Jerry,
I think it is possible to consider surgical exploration and possible repair at 3 months but you need to be prepared that the surgeon may not be able to bring it down to the original position.
Regards,
hc
Dear Jerry,
It should be still repairable at 6 weeks post-injury.
Regards,
hc
Hello,
I found this site while searching words associated with the odd “lump” and “divot” in my flexed quad muscle. Years ago I knelt down in a very cold house (I was very cold) and something popped. It was extremely painful at the time, and I had difficulty even walking. I assumed I pulled it, maybe even had a tear in it, I did not seek a medical opinion, I pull muscles all the time, I know the drill. I continued on applying ice at first, then heat later, tiger balm – all the other things I’m accustomed to doing (I play a lot of sports) when I injure muscles. Just the other day though I noticed that lump and became curious. I think this is what I’ve done as the pictures are identical to what my thigh looks like when flexed.
My question is – is there even any point in seeing a doctor at this stage – as years have elapsed since the original injury? I’m not even 100% sure that’s when I did it, though I do vividly remember the pain involved and nothing has been worse since. It does become aggravated and irritated quite easily when I’m doing sports (ball and ice hockey as well as martial arts and running are my primary sports) and results in ongoing problems and time having to be taken off. Is it best to try to strengthen my quads? I’m already doing this because of an ACL/MCL tear in my opposite knee. Is there anything else I can do to prevent re-injury at the site? Is stretching recommended?
Thanks very much,
Terri
Dear Terri,
It is not possible to repair the ruptured tendon/muscle from a chronic injury due to retraction and contracture of the muscle-tendon unit over time.
You can continue to stretch and strengthen your quads to prevent further injuries.
Regards,
hc
hello doctor. im a soccer player. 5 mount ago i was diagnosed with a partial tear in the quadriceps muscle. I made the necessary rehabilitation and returned to play as usual. Recently I started to feel ill and suddenly I created a bulge at the top of the thigh. I went to the doctor and he told me that apparently fully tore the muscle during my return. I want to know is it possible to analyze and restore muscle as much as possible in place?
Hi Cohen,
I suggest get an MRI scan to assess the tear and get a surgeon to surgically repair it This is what I would do.
However, please see your doctor to get his opinion. I have not examined you nor seen your investigations. I cannot offer a proper opinion through the internet.
Regards,
hc
I recently had this same surgery to repair my distal tear of rectus femoris tendon. There was very little if any tendon remaining at the site of the tear. I just completed my first week of rehab after being in straight leg brace for six weeks. I don’t think the surgery was a success. I am going to talk to surgeon soon. Do you know of any procedures that can be used to attach this type of tear? Is there any synthetic material that can be used? I assume I only have a short period of time to decide if I want a second surgery due to the retraction of the muscle.
Hi,
Most of these tears are at the distal musculotendinous junction. The amount of tendon is very little. The sutures have to be non-absorbable sutures and sewn using a Krakow’s technique type of stitching.
Why do u think that your repair was not a success?
Regards,
hc
Thanks for your response.
The muscle has a bulge again is the reason I think the surgery failed. I guess I will find out when I see the doctor again. I assume their will be another MRI.
If this surgery failed, is it possible to have a second surgery at this time to fix the first one? Injury on 7/27/15 and surgery on 9/11/15. It is now 7 weeks after surgery.
Yes. It is possible if you get it done early.
Regards,
hc
Hey, my leg looks the same as this guys does in the picture before surgery. I have had it for about 3 years and it looks the same. I have been walking, jumping and playing sports with little to no difference. Would surgery be recommended? Would it be stronger after or at its current state? I’m curious if there is any physical therapy that can help it without surgery. I’ve been trying to roll the muscle out from the top of my thigh.-Remy
I’ve had the very same problem for the past 9 months now i sustained the injury through soccer while i was taking a free kick (just heard a sudden pop sound) and i immediately stop playing and came off ..i stayed away from any football activities and treated the injury at home with some ice and some pain relieve cream i got from the pharmacy the pain got away just a week after and i felt 100% started jogging and such..but I’ve noticed the same separation in my leg with that mass forming i went to see a doctor after 5 to 6 month just to query about it coz i felt the swelling would decrease but i was told that it’s too late for a surgery ..now i just want to ask what the side effects would be if it remains like this? i can still run and play soccer with a aid of a thigh support please advice me what I should do regarding this injury