Endoscopic En-Bloc Resection of Calcific Tendinitis of Rectus Femoris: A Surgical Advance

Case Report

Austin Surg Case Rep. 2019; 4(1): 1030.

Endoscopic En-Bloc Resection of Calcific Tendinitis of Rectus Femoris: A Surgical Advance

Torres-Eguia R1, Abd El-Radi M1,2*, Trujillo LB1 and Guntin AM1

¹Department of Orthopedics and Traumatology, Chief of Hip Unit, Spain

²Department of Orthopedics and Traumatology, Assiut University Hospitals, Egypt

*Corresponding author: Mohamed Abd El-Radi Abd El-Salam, Department of Orthopedics and Traumatology, Assiut University Hospitals, Assiut, Egypt and Member of Joint Supervision Mission of Egyptian High Ministry of Education for M.D degree in Spain, Spain

Received: August 27, 2019; Accepted: September 27, 2019; Published: October 04, 2019


Purpose: The aim of this study is to show effectiveness of en-bloc resection technique as a treatment for rectus femoris calcific tendinitis.

Method: Five patients who underwent hip arthroscopy as treatment for calcific tendinitis of rectus femoris were retrospectively evaluated for pre and postoperative function and pain. Follow up ranged from 9 to 28 months (mean: 15.2 months). Mean age was 32.4 years, all patients were practicing football at recreational basis and right side was affected in four cases (80%).

Results: Mean scores for Western Ontario and McMaster Universities (WOMAC) and Hip disabilities and Osteoarthritis Outcome Score (HOOS), evolved from 74.4 to 91.7 points and from 77.7 to 91.2 points respectively.

Conclusion: En-bloc resection technique ensures complete resection of the calcific portion of rectus femoris and allows minimally invasive joint access offering rapid recovery and lower complication rate.

Keywords: Rectus Femoris; Calcification; Hip Pain; Hip Arthroscopy


Calcific tendinitis results from deposition of calcium hydroxyapatite crystals in tendinous tissue [1]. Multifactorial etiology including traumatic [1], genetic and metabolic issues [2,3] have been addressed as underlying causes of calcific tendinitis.

Calcific tendinitis presents mechanical pain with decreased range of motion and occasionally tenderness and warmness at affected joint [4]. In spite of it commonly affecting rotator cuff tendons, it is described in other periarticular regions such as elbow, wrist, knee and foot [5-7]. In hip region, chronic tendinopathy of the gluteus muscles is a well-recognized condition and is considered the second most frequently affected region after shoulder region [7-9]. However, calcification of rectus femoris was firstly described by King and Vanderpool as a rare disease in 1967 [8,9]. Later, a few cases of rectus femoris calcific tendinitis were reported with different treatment lines [4,7,10].

Conservative treatment is the first option including different methods such as rest, anti-inflammatory drugs or sometimes local steroid injections could be recommended. Surgical management is indicated when conservative treatment fails or symptoms are intractable and includes open removal through anterior approach [11] or endoscopic removal [7].

Arthroscopic resection is considered a minimally invasive technique to treat this condition, showing a rapid recovery. The aim of this study is to show our results when performing endoscopic enbloc resection to treat calcific tendinitis of the rectus femoris with a mean follow up 15.2 months.


Five patients were programmed for hip arthroscopy to treat calcific tendinitis of rectus femoris between August 2014 and February 2016. All patients were informed of procedure and possible complications with informed consents taken and IRB/Ethics Committee decided approval was not required for this study. They were evaluated retrospectively in our hip unit.

Patient’s ages ranged from 27 to 37 years (mean 32.4 years). All patients (100%) were male. The right side was affected in four patients (80%). All patients were regular football players on recreational basis.

All patients presented associated cam deformity (100%), one patient had pincer deformity (20%) and three patients had associated labral tear (60%).

Diagnosis was made based on clinical history, physical examination, and imaging procedures, which include plain radiographs, computerized topography and magnetic resonance imaging.

All patients referred chronic hip pain (more than 6 months duration), especially after sport practice. One patient (20%) had clear history of noted injury in the form of avulsed anterior inferior iliac spine 6 months before his visit to our unit.

Preoperative pelvic radiographs showed calcifications of the proximal part of rectus femoris (Figure 1AB). Computerized topography with three dimensional reconstruction was applied to assess shape of the lesion (Figure 2AB). Magnetic resonance arthrography were indicated in all patients to address associated lesions such as labral tears, chondrolabral injuries and cartilage damage as well as femoroacetabular impingement.