eduard alentorn geli - risk factors for rectus femoris muscle injuries

RISK FACTORS FORRECTUS FEMORIS MUSCLE INJURIES

Eduard Alentorn Geli MD, MSc, PhD, FEBOT, FACGME

Consultant, Orthopedic Surgery

Fundación García CugatArtroscopia GC, Hospital Quirón

Mutualidad de FutbolistasBarcelona, Spain

INTRODUCTION

Very common muscle injury (Ekstrand 2011)

Unique aspects: anatomy and pre-season incidence predominance

(Hasselman 1995; Orchard 2002; Woods 2002)

More missed games than other muscle injury locations

(Ekstrand 2011)

High re-injury rate 21% (Hagglund 2013)

INTRODUCTION

INTRODUCTION

RISK FACTORSINTRINSIC EXTRINSIC

PREVENTION

MODIFIABLE

RELEVANCE

INTRODUCTION

INTRODUCTION

PURPOSE:

To review the muscle-specific risk factors identified

RISK FACTORSIntrinsic factors

• AGE:– Incidence of muscle injuries

in general increases with age (Ekstrand 2011)

– Calf and hamstrings only muscle groups with significant increase in incidence of injury with age (Ekstrand 2011; Orchard 2001).

– Age = not a risk factor for quadriceps injury (Ekstrand 2011; Orchard 2001: Hagglund 2013)


• PREVIOUS INJURY:– Previous quadriceps and hamstring muscle injury

increase risk RF injury in AF (Orchard 2001)

– HT injury reduced stride length as a protective mechanism, but might be harmful for RF


• PREVIOUS INJURY:– Previous injury not a risk factor in soccer: only 7

injuries (Fousekis 2011)

– Quadriceps injury the season before increased risk of injury in soccer: HR 3.10; 95% CI 2.21-4.36 (Hagglund 2013)

– Risk also increased for adductors and calf muscle injuries in the preceeding season in soccer (Hagglund 2013)


• ANTROPOMETRIC CHARACTERISTICS:– Heavier and shorter individuals had a trend towards

higher risk of quadriceps muscle injuries (Fousekis 2011).– Only 7 quadriceps injuries (only trend).


• ANTROPOMETRIC CHARACTERISTICS:– Height below 1.82cm increased risk of quadriceps

injury compared to taller players in AF (Orchard 2001)

– Body size is not associated with increased risk of quadriceps muscle injuries in soccer (Bradley 2007)

– Stature and body mass not associated with risk of quadriceps muscle injury in soccer (Hagglund 2013)


• DOMINANCE:– Significantly more quadriceps muscle injuries in the

dominant vs non-dominant leg in soccer players• 60% vs 33% (Ekstrand 2011)

• 63% vs 37% (Hagglund 2013)

– Quadriceps injuries more common in dominant kicking leg in AF (RR 2.13 1.59-28.6 95% CI) (Orchard 2001)

– No significant differences for hamstring, adductors, and calf muscles (Ekstrand 2011; Orchard 2001)


• DOMINANCE:– No differences in rate of dominant vs non-dominant

side injury between patients with or without quadriceps muscle injury in soccer players:• N=6 injuries (Bradley 2007)

• N=13 injuries (Witvrouw 2003)


• FLEXIBILITY:– Injured soccer players had lower pre-season

quadriceps muscle flexibility compared to non-injured players (Witvrouw 2003)


• FLEXIBILITY:– Trend towards quadriceps flexibility asymmetries in

injured soccer players (Fousekis 2011)


• FLEXIBILITY:– Quadriceps flexibility was not different between

quadriceps injured and non-injured soccer players (Bradley 2007)

– Only 6 quadriceps muscle injuries.


• STRENGTH:– Preseason concentric isokinetic knee extensors strength

not risk factor for quad injuries in soccer players (Fousekis 2011)

– Preseason eccentric isokinetic knee extensors strength differences in injured compared to uninjured: OR 5.01, 0.92-27.14 95% CI) (Fousekis 2011)

RISK FACTORSExtrinsic factors

• SPORT:– Sprinting and kicking: not proven but most commonly

occur in these actions (Mendiguchia 2012)

– Champions League less risk than home leagues (Hagglund 2013)

• PLAYING POSITION:– Not a risk factor for knee extensors injury (Bradley 2007)

– Decreased risk in goalkeepers (Hagglund 2013)


• TIME OF THE SEASON:– More quadriceps injuries during pre-season: Rectus

femoris was the most common (29%) (Woods 2002)

– Significant differences between pre- and in-season incidence of rectus femoris and biceps femoris injuries (Woods 2002)

– No differences between in-season and pre-season in soccer (Hagglund 2013)


• FIELD:– Higher quadriceps injuries after low rainfall week

with dryer and harder field in AF (Orchard 2001)

– No differences between northern (marine west coast)/southern (Mediterranean) climates in European soccer (Hagglund 2013)


• FIELD:– More quadriceps injuries during pre-season: Rectus

femoris was the most common (29%) (Woods 2002)

– Ground condition was dry in 70% of cases in pre-season (Woods 2002)

– Not a risk factor analysis.

SUMMARY OF STUDIES

PARAMETER YES NO VEREDICTAge 0 3

SUMMARY OF STUDIES


Previous injury 2 1 (1)

SUMMARY OF STUDIES



Shorter 1 2 (1)

SUMMARY OF STUDIES



Shorter 1 2 (1)

Heavier 0 3

SUMMARY OF STUDIES



Shorter 1 2 (1)

Heavier 0 3

Dominant 3 2 (2)

SUMMARY OF STUDIES



Shorter 1 2 (1)

Heavier 0 3

Dominant 3 2 (2)

Flexibility 1 2 (2)

SUMMARY OF STUDIES



Shorter 1 2 (1)

Heavier 0 3

Dominant 3 2 (2)

Flexibility 1 2 (2)

Strength (eccentric) - 1 (1)

SUMMARY OF STUDIES



Shorter 1 2 (1)

Heavier 0 3

Dominant 3 2 (2)

Flexibility 1 2 (2)


Position 1 1 (1)

SUMMARY OF STUDIES



Shorter 1 2 (1)

Heavier 0 3

Dominant 3 2 (2)

Flexibility 1 2 (2)


Position 1 1 (1)

Pre-season 1 1

SUMMARY OF STUDIES



Shorter 1 2 (1)

Heavier 0 3

Dominant 3 2 (2)

Flexibility 1 2 (2)


Position 1 1 (1)

Pre-season 1 1

Dry field 1 1 (1)

The RF risk factors modelBahr and Krosshaug, BJSM 2005

The RF-RF modelAdapted from Bahr and Krosshaug, BJSM 2005

Fatigue

Warm-up

Contractile properties

Muscle imbalance

Intermuscular coordination

Core stability. . .

Previous injury

Anthropometrics Dominance

Flexibility Strength

PREDISPOSED ATHLETE

?

SUSCEPTIBLE

ATHLETE

DRY FIELD

INJURY

SPRINTINGKICKING

PositionPREVENTION

CONCLUSIONS

EVIDENCE FOR QUADRICEPS

LIKELY•Previous injury•Shorter individuals•Dominant leg•Decreased flexibility•Side-to-side differences in eccentrinc isokinetic knee extensors strength•Dry field•Player position

DOUBTFUL•Heavier individuals•Side-to-side differences in concentric isokinetic knee extensors strength•Pre-season

CONCLUSIONS

FURTHER RESEARCH

CONFIRM RISK FACTORS DISCOVER NEW ONES

REDUCE RECTUS FEMORIS INJURIES

PREVENTION PROGRAMS

THANK YOU!!!!!

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eduard alentorn geli - risk factors for rectus femoris muscle injuries

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