0:00

This is the first case of the second part.

0:03

That's the case number five, uh, 30-year-old male

0:07

with anterior fight pain after kicking a ball one day ago.

0:12

So that's, that's, that's the history.

0:14

And when we see the images of the hip of the patient,

0:19

we can see that this patient has a lesion, uh,

0:24

at the rectus femoral muscle, right?

0:28

As Dr. Mini Patria told.

0:30

The anatomy of this muscle is somewhat

0:32

different from the rest.

0:34

And we, we can see the direct head

0:37

and indirect head of the rectus femoris.

0:40

The central part is the indirect head,

0:44

and this peripheral part is the direct head.

0:47

And in this case, we have two lesions

0:50

and are two characteristic lesions

0:52

that we can see in this muscle.

0:54

The first lesion that is more proximal right here,

0:58

it's a partial tear of the myo,

1:03

uh, myofascial

1:04

or myop aortic, uh, junction of the posterior portion

1:09

of the direct, uh, head of the, of the,

1:14

of the rectus femoral.

1:15

So the, the indirect head is here, the, in the direct head,

1:19

it's around the indirect head.

1:22

So here is a part of the direct head that we can see, uh,

1:27

a lot of lesions in this place.

1:29

I work more than 20 years

1:31

with soccer players here in my city.

1:35

We have like, there are three team, three teams,

1:38

or sometimes two teams on the first soccer division,

1:43

uh, of Brazil.

1:44

And we see this cases a lot.

1:47

And this is a place, this is a place that we see

1:50

many lesions of rectus femoris have this proximal, uh,

1:56

neo fascial or neo neurotic junction

1:59

of the direct head of the tandem.

2:02

And the other place that we see a lot of lesions in

2:06

that we are seeing,

2:07

that we are seeing a lesion right here is the indirect head

2:11

of rectus fems.

2:13

This here, uh, we call this the, the, the direct, uh,

2:18

let me just put my, my

2:21

my, my PowerPoint here.

2:24

We call this the pro, the central tend

2:27

of the hetus fems, uh, the orthopedic surgeons, the, the,

2:33

the, that, that deals with, uh, soccer players.

2:36

They call this, that the di direct, the, the central tend

2:39

of the rectus fems.

2:40

That is the indirect, uh, head of the rectus fems

2:45

and the tandem it's ruptured.

2:47

And between these two lesions, the lesion that is worst

2:52

for the athlete, that's worst for the patient is this lesion

2:57

of the indirect, of the

2:59

Central, tend of the rectus femoris.

3:02

Um, as Dr.

3:03

Minnie Patria said, uh, in the British, uh, classification,

3:08

the lesions that get that rupture,

3:10

the tendons are the lesions that, uh, uh, the patient has,

3:15

uh, uh, a worse prognosis

3:18

or it, uh, delays the return to play of the,

3:22

the patient at the Sal plane.

3:24

We can see the two lesions right here.

3:26

Here is the proximal lesion at the, uh, neo neurotic

3:31

or the neo fascial junction of the direct head

3:34

of the rectus femoris.

3:35

And here is the tear at the central tendon

3:39

of the rectus femoris that is part of the indirect head

3:44

of the rectus femoris at the coronal plane.

3:47

We can also see, uh, here is the,

3:50

is the posterior lesion, uh, of the direct head of the,

3:54

the rectus femoris.

3:56

And here is the more anterior lesion that is the lesion

4:00

of the indirect head of the Hector Femoris, the central tend

4:04

of the hec, rectus femoris.

4:06

And talking about like, uh, the, the doc, the doctors here.

4:09

When I, uh, report a case like that for an athlete,

4:14

especially soccer players, the, the doctors of the teams,

4:17

they like that I put like the British

4:20

classification in my report.

4:22

Uh, but otherwise I just describe the lesion.

4:27

I just describe the findings,

4:29

and I usually don't put, uh,

4:34

any kind of classification.

4:36

Uh, if the patient is not an athlete

4:39

or if the do the orthopedic surgeon, they, they, uh, he

4:43

or she, uh, doesn't ask direct for me.

4:47

So that's the way that w that I do here, uh, with patients.

4:52

And by the way, some of the orthopedic surgeons, most

4:54

of them that they don't deal with athletes, they don't, uh,

4:57

know very well this classification.

4:59

And it's also something new for them.