• Jocelyn Wittstein, Steven Klein, and William E Garrett.
• Duke University Medical Center, Durham, North Carolina, USA. jocelynwittstein@hotmail.com
• Am J Sports Med. 2011 Sep 1; 39 (9): 1942-7.

BackgroundWhile the majority of quadriceps muscle strains can be managed nonoperatively, rare cases remain symptomatic despite nonoperative treatment.PurposeThe purpose of this study is to report on results of surgical treatment of a limited number of cases of persistently symptomatic tears of the reflected head of the rectus femoris.Study DesignCase series; Level of evidence, 4.MethodsThe records of 5 patients with chronic tears of the rectus femoris treated with excision of the reflected head were reviewed. A telephone interview regarding return to sport and current limitations was completed if patients were available for further follow-up.ResultsA review of 5 cases of surgical treatment of chronic tears of the reflected head of the rectus was completed. Patients included 1 woman and 4 men with an average age of 21 years (range, 18-24 years). Three patients played football (2 kickers) and 2 played soccer at a collegiate level. All 5 reported a significant decrease in pain during sport and activities of daily living and were able to return to collegiate athletics. Two patients had a late recurrence of pain with kicking that resolved with nonoperative treatment, 1 had residual thigh pain with intense play, 1 had no pain but noted decreased kicking accuracy, and 1 patient returned to play without symptoms.ConclusionStrain injuries to the reflected head of the rectus femoris can benefit from delayed excision in rare cases that fail nonoperative management. High-level kicking athletes are likely to experience significant reduction in pain, but may have some residual or recurrent symptoms that limit competitive level of play postoperatively.

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