Rectus femoris heterotopic ossification refers to the ossification/formation of extra skeletal bones in the direct or indirect tendons of the rectus femoris muscle, following tendon injury or chronic tendinopathy.
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Clinical presentation
Whilst generally asymptomatic, it can cause:
hip pain 1
reduced mobility of the hip joint
soft tissue swelling
Epidemiology
It is often seen in young adult males, athletes, and soccer players with history of previous trauma. 1,2
Radiographic features
Plain radiographs
Early-stage tendinopathy or injury is not seen on plain radiographs. After mineralization and maturation, a linear, well-corticated soft tissue calcification involving the direct or indirect rectus femoris tendons can be seen.
CT / MRI
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early stage
soft tissue edema or mass with rectus femoris tendon thickneing 1
it may demonstrate contrast enhancement
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mineralization
calcifications generally starts peripherally and a central fatty marrow component can sometimes be seen
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maturation
a linear, well-corticated soft tissue calcification involving the direct or indirect rectus femoris tendons
soft tissue or adjacent bone edema if there is an associated ossification fracture.
Treatment and prognosis
The gold standard treatment are analgesics and physical therapy, but surgical removal of the excess bone is indicated in some cases 2,3.
Complications
The main complications are avulsion injury or fracture of the heterotopic ossification.
Differential diagnosis
Alternative diagnosis include:
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anterior inferior iliac spine avulsion injury
the bone fragment is not corticated from its inner and outer surfaces and there is an iliac bone cortical defect
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unlike heterotopic ossification, there is medullary and cortical continuation
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the calcifications involves the muscle not he the tendon
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