Quadriceps Injuries

About Quadriceps Injuries

Quadriceps muscle injuries are the second most common seen in sport after hamstring injuries and occur during sports with explosive kicking or high speed sprinting, such as soccer, American football and rugby. Several injuries can occur throughout the length of the quadriceps muscle group with the most common type at the rectus femoris musculotendinous junction (MTJ). Proximal tendon avulsions are the most frequently reported in the literature, but largely through case series.

These injuries are usually treated non operatively but can be extremely limiting for the elite level sportsperson. Severe grade rectus femoris injuries have a varied prognosis in the literature with delays in return to pre-injury level of sport and recurrence rates as high as 67% in the elite-level athlete.

Quadriceps injuries can present in two ways: 1. Acute tear with the audible ‘pop’ and pain immediately after the event of kicking, sprinting or rapid hyperextension of the hip. 2. Insidious onset with discomfort along the anterior thigh whenever kicking is performed. This can be mistaken for overuse, with the player able to continue. The pain increases in severity until finally imaging is recommended demonstrating the severity of the injury. On Examination there may be swelling present with pain on stretching, palpation at the site of injury and resisted knee extension. A palpable gap may be felt between the sartorius and tensor fascia lata in proximal avulsions. The retracted tendon may be felt more distally and exaggerated by quadriceps contraction. Thorough examination and neurological examination is needed to exclude other pathologies.

The mechanism of injury from sprinting is different from the typical kicking mechanism with gait analysis showing the primary function of the quadriceps muscle group is to control deceleration of knee flexion at heel strike. This sudden deceleration during sprinting causes high velocity forces that may cause rupture.