Treatment of Direct Head of the Rectus Femoris Injury with PRP Therapy in a Division I Basketball Player

Quinn Matthew,Tabaddor Ramin R,Lemme Nicholas,Salko Phillip

doi:10.23937/2469-5718/1510137

Abstract

A 20-year-old Division I collegiate basketball player with a previous medical history significant for recurrent left patellar tendinopathy presented to us after sustaining an injury to his left thigh that occurred while jumping during a basketball game. Physical examination was performed two days later and revealed a diffusely swollen and engorged left thigh. There was a noticeable defect of the mid to proximal quadriceps along the RF at the musculotendinous junction anteriorly. He experienced tenderness along the musculotendinous junction of the rectus, the mi substance of the quadriceps, and the quadriceps tendon. No palpable defect of the quadriceps tendon was appreciated. Patient was able to obtain and maintain a straight leg raise.

Highlights

The Rectus Femoris (RF) is the most commonly injured quadriceps muscle and is second only to the hamstring in prevalence amongst lower extremity injuries occurring in athletes [1,2,3]
While the lack of standardization in Platelet Rich Plasma (PRP) preparations has kept it from garnering robust high quality study results, many smaller studies and meta-analyses have produced statistically significant results demonstrating the efficacy of PRP therapy in the management of injuries to various structures such as the rotator cuff, gluteus medius, and patellar tendon [6,7]
The rationale behind the removal of these cell types stems from data that has shown that higher concentrations of leukocytes, NE, found in Leukocyte-Rich Preparations (LRP) may deliver more pro-inflammatory cytokines and proteases that inhibit tissue healing and delay recovery time than Leukocyte-Poor Preparation (LPP) [7,14]

Summary

Introduction

The Rectus Femoris (RF) is the most commonly injured quadriceps muscle and is second only to the hamstring in prevalence amongst lower extremity injuries occurring in athletes [1,2,3]. Clinical examination 15 days after PRP injection demonstrated full strength about the hip and knee, resolution of the palpable proximal defect, and a mild decrease in hip extension. He was sent for repeat imaging that day to radiographically confirm interval improvement and clear him for progression to full activity. At this time, MRI revealed a near complete resolution (> 90% decrease) of the grade II myotendinous junction strain of the direct head. Given an otherwise benign clinical examination and significant improvement on imaging, the patient was cleared to begin a Return to Play (RTP) protocol under the supervision of his athletic trainer. Over the course of the three days, the patient demonstrated the ability to perform sport specific drills and activities without limitations or symptoms and was cleared for return to full activities

Findings

Discussion

Conclusion