Indirect Rectus Femoris Injury Mechanisms in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings

Abstract

<p><b>Objective</b>:<br>To describe injury mechanisms and magnetic resonance imaging (MRI) findings in acute rectus femoris (RF) injuries of soccer players using a systematic video analysis.<br><b>Design</b>:<br>Descriptive case series study of consecutive RF injuries from November 2017 to July 2022.<br><b>Setting</b>:<br>Two specialized sports medicine hospitals.<br><b>Participants</b>:<br>Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after a RF injury, with an available video footage of the injury and a positive finding on an MRI.<br><b>Independent Variables:</b><br>Rectus femoris injury mechanisms (specific scoring based on standardized models) in relation to RF muscle injury MRI findings.<br><b>Main Outcome Measures:</b><br>Rectus femoris injury mechanism (playing situation, player/opponent behavior, movement, and biomechanics), location of injury in MRI.<br><b>Results</b>:<br>Twenty videos of RF injuries in 19 professional male soccer players were analyzed. Three different injury mechanisms were seen: kicking (80%), sprinting (10%), and change of direction (10%). Isolated single-tendon injuries were found in 60% of the injuries. Of the kicking injuries, 62.5% included complete tendon ruptures, whereas both running injuries and none of the change of direction injuries were complete ruptures. The direct tendon was involved in 33% of the isolated injuries, and the common tendon was affected in all combined injuries.<br><b>Conclusions:</b><br>Rectus femoris injuries typically occur during kicking among football players. Most of the RF injuries involve a complete rupture of at least one tendon. Kicking injuries can also affect the supporting leg, and sprinting can cause a complete tendon rupture, whereas change of direction seems not to lead to complete ruptures.</p>