ramon balius. senior researcher and sports medicine specialist at the sport catalan council....
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Return to sport in adductors injuries. From scientific to practical experienceTRANSCRIPT
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.