ramon balius. senior researcher and sports medicine specialist at the sport catalan council....

Ramon Balius Carles Pedret Mireia Bossy

Rectus Femoris Involved in the formation of the quadriceps tendon Bipennate Muscle Double proximal insertion Single Distal Insertion

Proximal UMT Direct Insertion

AIIS Aponeurotic Superficial Expansion

Indirect Insertion Upper edge of the acetabulum Intramuscular Septum Produces bipennate apperence

Distal UMT Quadricipital tendon

Aponeurotic Superficial Expansion (Posterior Fascia)

SYMPTOMS Acute Disabling Pain or Initial Minimal Pain (Progressive Onset Pain) Progressive loss of function Hack deformity Variable stump depending on UMT Muscle Smearing Rarely bruising

“A muscle-within-muscle”

RF Myotendinous Injury depending the UMT injured 1.  Intramuscular Septum. Central Tendon Injury 2.  Superficial Expansion from Direct tendon. Superficial Injury 3.  Distal Posterior Fascia. Distal Peripheral Injury 4.  Proximal Posterior Fascia. Proximal Peripheral Injury

1.  Intramuscular Septum. Central Tendon Injury

Shor stump Smearing evident Palpable depresion Bad Prognosis

1.  Intramuscular Septum. Central Tendon Injury

Acute Lesion Low fluid collection

“Like a cannelloni” Band tendon Bad prognosis image

2. Superficial Expansion from Direct tendon Involvement. Superficial Injury

Rare Few Symptoms No stump and minimum myofascial hematoma US/MR careful: do not confuse with tendon injury

3.  Distal Posterior Fascia Involvement: Distal Peripheral Injury

Sometimes large stump, sometimes high Myofascial Fluid Laminar fibrous scar Good prognosis

US evolution: Cystic Hematoma (similar evolution to Tennis Leg)

Cross i cols, 2004

Length of Injury CSA of Injury

Cook et Al, (2004)

Proximal level: the RTP: 45.1 days (injury: 4cm) This value increases 5.3 days with each 1 cm increase in the length of injury.

Distal level: RTP: 32.9 days (injury: 3.9cm)

This value increases by 3.4 days with each 1 cm increase.

Balius et Al, (2009)

4. Proximal Posterior Fascia Involvement. Proximal Peripherical Injury

No stump Often asymptomatic Liquid Collection "on eye" Characteristic fibrous scars

European Journal of Radiology, 2012

CONCLUSIONS

•  Knowledge of RTP in the RF is very limited It is based on the assessment of Imaging Tests

•  It has been studied only central tendon lesion compared with peripheral: - RTP central tendon is the RTP LONGEST peripheral lesion - Longer length and RTP area RF lesion implies more RTP.