**6. Quadriceps femoris**

mended only in cases of injury at the sternoclavicular origin, in some partial tears, in older or

This lesion was classified and reported in literature for the first time by Patissier in 1822 and since then over 200 cases have been reported [22]. The number of these lesions has increased and the increase in the last 30 years is due to the increased participation in heavy physical activity such as weight lifting, weight training, wrestling, rugby and waterskiing. Attributable almost solely to males, these lesions occur in an age range from 16 to 91 years with a peak in athletes aged between 20 and 40 years [22]. The most common mechanism is indirect trauma during bench pressing or other weight lifting movements; less frequent injuries are those

The lesion of this muscle may occur in different zones. Tietjen [24] used a classification divided into 3 groups: type I consists of muscle contusions and sprains; type II partial tears and type III complete lesions. Each of these groups has a subclassification based on the location of the lesion: A - muscle origin; B - belly muscle; C - myotendinous junction; D - tendon. Statistically, insertion tendon injuries are the most frequent (55%), lesions to the belly or muscular-tendon

According to the most recent meta-analysis [23] early surgical treatment achieves significantly better results than conservative treatment with an excellent-good result in 90% of cases, compared with 17% of conservative treatment (P = 0.00000001). When surgery is delayed

While for partial lesions treatment with conservative immobilization for 2-3 weeks is indicated, where surgery is required immobilization should be 4-6 weeks and subsequently a gradual lengthening of the muscle must be performed and only after 6-12 weeks strength training can

The lesion of the biceps usually involves the tendon portion, more often the long proximal head and to a lesser extent the distal end that inserts into the radial tuberosity. Sometimes biceps muscle tears occur in the belly, especially when the arm remains entangled in ropes during some sports such as skydiving and wakeboarding [25, 26]. Less frequently, the muscle

Complete laceration of the muscle belly of the biceps brachii leads to a loss of muscle strength and unfortunately, few data are available in literature regarding the right choice of treatment. One of the few studies to have compared the effects of a surgical muscle suture with conser‐ vative treatment is the one by Kragh and Basamania in 2002 [25]. In a military base in North Carolina with 25,000 paratroopers, the authors performed nine surgeries in a year and compared the results to those of three patients treated conservatively in previous years. The paratroopers treated surgically achieved significantly better results for strength (measured in supination torque) and appearance. Those who had been treated conservatively had a worse

following abduction-external rotation, extension-adduction and direct trauma [23].

slightly worse results are obtained, especially after 13 weeks from injury.

belly can break following direct trauma in a car accident [27].

sedentary individuals.

226 Muscle Injuries in Sport Medicine

begin.

**5. Biceps brachii**

insertion cover about 35% of these injuries [23].

No cases of suturing subcutaneous belly lacerations of the quadriceps femoris are described in literature. The only description is in a surgical case report by Straw [28]. The tear had occurred at the proximal musculotendinous junction. With surgery muscular performance improved 151% to concentric power after 6 months compared to preoperative levels.
