PROXIMAL SARTORIUS TENDON RUPTURE AS A CAUSE OF TRAUMATIC ANTERIOR HIP PAIN-A CASE REPORT OF A PROFESSIONAL FOOTBALLER
Background Sartorius injuries are seldom mentioned in medical literature. Thus developing an evidence-based management plan for sartorius muscle and tendon injuries can be challenging. In this case a grade 3 tear of the proximal sartorius tendon was identified in a player following a high-velocity contact injury to the pelvis during a professional match.
Methods The athlete was able to continue playing for a further 30 minutes following the injury, but ultimately increasing pain and restriction in hip movements forced him to limp off. Examination revealed localised swelling, bruising and tenderness at the site of contact to the left anterior-superior iliac spine (ASIS), and painful muscle contraction. This was managed to good effect as a presumed muscle contusion, but with recurrence of symptoms, further swelling, bruising and limping by half time in the subsequent match one week later. The presumed contusion was thought to have deteriorated forming a suspected 10cm muscle haematoma. The merits of blind and sonography-guided aspiration were considered, and the latter option was chosen.
Results Ultrasonography revealed soft tissue oedema and injury to the proximal sartorius tendon, and aspiration was therefore not attempted. A subsequent MRI scan demonstrated a grade 3 sartorius tendon tear at its insertion to the ASIS with 3cm separation. With no specific guidance available in the medical literature, consensus of opinion was to continue with conservative management. Rehabilitation methods were modified according to the new findings.
Given importance of this player in the team and the next match being a cup final a week later, a pragmatic approach was taken to allowing him to play; he played effectively for one hour before he showed signs of limping.
He went on to have three, weekly Prolotherapy injections into the site of the tear in order to facilitate healing in the off-season. Progressive rehabilitation of his thigh resulted in return to uninhibited play within six weeks.
▸ The history and physical examination findings, as well as initial good response to conservative treatment of a presumed simple contusion provided our medical team false assurance and a small delay in the diagnosis of this rare injury.
▸ Attaining the exact diagnosis allowed a more hands-on and bespoke rehabilitation program, as well as informed decision-making as to suitability to play in a crucial match.
▸ The rarity of this injury and negligible functional deficit that results from a ruptured proximal sartorius tendon following good rehabilitation perhaps accounts for the paucity of medical literature available.
▸ We ask the audience to consider a sartorius tendon rupture in the differential diagnosis of acute anterior hip pain.