Traumatic Proximal Rectus Femoris Avulsion With Recurrent Intramuscular Hematoma in a Competitive Martial Arts Athlete: A Case Report

Proximal avulsion of the rectus femoris tendon is an uncommon injury in athletes and is rarely associated with direct trauma and extensive hematoma. We describe a 25-year-old competitive taekwondo athlete who developed acute hip flexor weakness and thigh swelling after a direct anterior thigh kick. Bedside musculoskeletal ultrasound demonstrated disruption of rectus femoris architecture with intramuscular hematoma, and magnetic resonance imaging confirmed complete avulsion of both proximal heads of the rectus femoris with tendon retraction and a large associated hematoma. The patient had sustained a recent prior quadriceps injury with hematoma. Recurrent hematoma development warranted hematologic testing, which revealed an isolated Factor VIII deficiency. Given his high functional demands, he underwent open surgical repair. This case highlights the importance of early imaging and consideration of operative management in high-level athletes presenting with trauma-related rectus femoris avulsion. It also highlights the importance of hematologic workups in athletes presenting with unexplained recurrent hematomas to effectively risk-stratify surgery and return to sport.