A 22-year-old footballer sustained a direct blow to the anterior thigh 8 weeks ago. He now has progressive restriction of knee flexion and a firm mass in the quadriceps. Radiograph shows irregular ossification within the vastus medialis. What is the most appropriate management at this stage?
- A Gentle active assisted range of motion exercises with avoidance of forced passive stretching ✓
- B Excision of the ossified mass followed by radiotherapy
- C Deep friction massage of the thigh twice daily
- D Immobilization of the knee in flexion for 4 weeks
Correct answer: A. Gentle active assisted range of motion exercises with avoidance of forced passive stretching
Explanation
This is myositis ossificans traumatica of the quadriceps. In the immature phase the lesion is actively enlarging and vascular, so surgery is contraindicated because excision precipitates recurrence. Treatment is protected mobilization with gentle active assisted movement; forced passive stretching and deep massage worsen bleeding and ossification. Excision is deferred until the lesion matures, indicated clinically by a falling serum alkaline phosphatase and radiographically by a sharp border, usually 6 to 12 months after injury.
Reference: Miller's Review of Orthopaedics, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.