Operative versus conservative treatment of proximal rectus femoris avulsions: A systematic review with meta-analysis of clinical outcomes, complications and return to sports.
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.
['Dalal|Shaival|S|', 'Kotwal|Rahul|R|', 'Chandratreya|Amit|A|']
Proximal Rectus Femoris Avulsions Outcomes Return Sports