PROSPERO REGISTRATION NUMBER: CRD42020198333. OBJECTIVE: To compare the surgical and conservative treatment of proximal rectus femoris avulsions regarding clinical outcomes, rate of return to sports and incidence of complications. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Cochrane, Medline, Scopus and SPORTDiscus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies reporting on outcomes of PRFAs or return to sports were included. RESULTS: Nine studies consisting of a total eighty-two patients met the inclusion criteria. The mean age was 22.2 years and 75.9% of patients were male. Mean follow-up was 28.9 months and 65% avulsions were managed surgically. The overall outcomes were similar in surgical and conservative treatment group (p = 0.72) with similar incidence of complications (14%). The rate of return to sports was 95% in surgical and 92.7% in the conservative management groups (p = 0.93). Overall, the quality of the methodology of included studies was low, with a mean CMS of 45.6. CONCLUSION: Both conservative and operative treatment provide excellent outcomes in proximal rectus femoris avulsions, with similar rates of return to sports and incidence of complications. More prospective and good quality studies are needed to compare surgical techniques and time to return to sports. Avulsions with retraction of more than 20 mm and high demand patients may benefit from surgical treatment. Patients should be counselled accordingly.
PROSPERO REGISTRATION NUMBER: CRD42020198333. OBJECTIVE: To compare the surgical and conservative treatment of proximal rectus femoris avulsions regarding clinical outcomes, rate of return to sports and incidence of complications. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Cochrane, Medline, Scopus and SPORTDiscus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies reporting on outcomes of PRFAs or return to sports were included. RESULTS: Nine studies consisting of a total eighty-two patients met the inclusion criteria. The mean age was 22.2 years and 75.9% of patients were male. Mean follow-up was 28.9 months and 65% avulsions were managed surgically. The overall outcomes were similar in surgical and conservative treatment group (p = 0.72) with similar incidence of complications (14%). The rate of return to sports was 95% in surgical and 92.7% in the conservative management groups (p = 0.93). Overall, the quality of the methodology of included studies was low, with a mean CMS of 45.6. CONCLUSION: Both conservative and operative treatment provide excellent outcomes in proximal rectus femoris avulsions, with similar rates of return to sports and incidence of complications. More prospective and good quality studies are needed to compare surgical techniques and time to return to sports. Avulsions with retraction of more than 20 mm and high demand patients may benefit from surgical treatment. Patients should be counselled accordingly.
Authors: Harish S Hosalkar; Andrew T Pennock; Daniela Zaps; Matthew R Schmitz; James D Bomar; Bernd Bittersohl Journal: Hip Int Date: 2012 Jul-Aug Impact factor: 2.135