Return to sport in adductors injuries. From scientific to practical experience

1. Ramon Balius
Carles Pedret
Mireia Bossy

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

3. Proximal UMT
Direct Insertion
AIIS
Aponeurotic Superficial Expansion
Indirect Insertion
Upper edge of the acetabulum
Intramuscular Septum
Produces bipennate apperence

4. Distal UMT
Quadricipital tendon
Aponeurotic Superficial Expansion (Posterior Fascia)

5. 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

6. “A muscle-within-muscle”

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

8. 1. Intramuscular Septum.
Central Tendon Injury
Shor stump
Smearing evident
Palpable depresion
Bad Prognosis

9. 1. Intramuscular Septum.
Central Tendon Injury
Acute Lesion
Low fluid collection
“Like a cannelloni”
Band tendon
Bad prognosis image

11. 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

12. 3. Distal Posterior Fascia Involvement:
Distal Peripheral Injury
Sometimes large stump, sometimes high
Myofascial Fluid
Laminar fibrous scar
Good prognosis

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

15. Cross i cols, 2004

16. Cook et Al, (2004)
Length of Injury
CSA of Injury

17. 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)

18. 4. Proximal Posterior Fascia Involvement.
Proximal Peripherical Injury
No stump
Often asymptomatic
Liquid Collection "on eye"
Characteristic fibrous scars
European Journal of Radiology, 2012

19. 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.