Rehabilitation after a Complete Avulsion of the Proximal Rectus Femoris Muscle: Considerations from a Case Report

Christian Baumgart, Casper Grim, Rafael Heiss, Philipp Ehrenstein, Jürgen Freiwald and Matthias Wilhelm Hoppe
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Christian Baumgart: Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119 Wuppertal, Germany
Casper Grim: Department of Orthopedic and Trauma Surgery, Klinikum Osnabrück, Am Finkenhuegel 1, 49076 Osnabrueck, Germany
Rafael Heiss: Institute of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany
Philipp Ehrenstein: Practice OrthoPro Duesseldorf, Breitestr 69, 40213 Duesseldorf, Germany
Jürgen Freiwald: Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119 Wuppertal, Germany
Matthias Wilhelm Hoppe: Institute of Movement and Training Science, University of Leipzig, Jahnallee 59, 04109 Leipzig, Germany

IJERPH, 2021, vol. 18, issue 16, 1-19

Abstract: Background: A complete avulsion of the proximal rectus femoris muscle is a rare but severity injury. There is a lack of substantial information for its operative treatment and rehabilitation; in particular there is a lack of biomechanical data to evaluate long-term outcomes. Case presentation: The case report presents the injury mechanism and surgical treatment of a complete avulsion of the proximal rectus femoris muscle in a 41-year-old recreational endurance athlete. Moreover, within a one-year follow-up period, different biomechanical tests were performed to get more functional insights into changes in neuromuscular control, structural muscle characteristics, and endurance performance. Within the first month post-surgery, an almost total neuromuscular inhibition of the rectus femoris muscle was present. A stepwise reduction in inter-limb compensations was observable (e.g., in crank torque during cycling) during the rehabilitation. Muscular intra-limb compensations were shown at six months post-surgery and even one year after surgery, which were also represented in the long-term adaption of the muscle characteristics and leg volumes. A changed motor control strategy was shown by asymmetric muscle activation patterns during ergometer cycling, while the power output was almost symmetric. During rehabilitation, there might be a benefit to normalizing neuromuscular muscle activation in ergometer cycling using higher loads. Conclusions: While the endurance performance recovered after six months, asymmetries in neuromuscular control and structural muscle characteristics indicate the long-term presence of inter- and intra-limb compensation strategies.

Keywords: muscle injury; tendon rupture; quadriceps; surgery; strength; electromyography; rehabilitation; isokinetic (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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