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Definitive management of thigh contusions in athletes: but how definitive? A systematic review
  1. Brittany E Haws,
  2. T David Luo,
  3. Ian M Al'Khafaji,
  4. Jason P Rogers,
  5. Daniel B Botros,
  6. Michael T Freehill
  1. Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Michael T Freehill, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA; freehill{at}


Importance Thigh contusion is a common injury reported in athletes; however, the optimal treatment guidelines for thigh contusions, potentially leading to haematoma, in the athletic population remain ill-defined. To the best of our knowledge, this is the most comprehensive review of the literature.

Objective A systematic review of the literature was performed regarding the appropriate management and timing of non-surgical and surgical intervention of thigh haematomas in athletes to determine an optimal treatment algorithm. Specifically, we aimed to compare these treatment options with respect to time to return to sport.

Evidence review Two databases (PubMed and SPORTdiscus) were used in this systematic review. Search terms included ‘thigh contusion’, ‘thigh hematoma’, ‘quadriceps contusion’, ‘quadriceps hematoma’, ‘treatment’, ‘athlete’ and ‘sports’. The inclusion criteria were (1) athletes of any age that sustained thigh contusions caused by sports-related trauma, (2) data relating to treatment outcomes of thigh haematomas, (3) clinical studies with level I–IV of evidence from any year of publication and (4) studies published in English.

Findings 7 studies met our inclusion criteria and were reviewed, all of which were level IV evidence. 6 of the studies involved non-operative management of the patients, and only one study involved surgical intervention. The average time until return to play across the studies with non-operative treatment was 29.3 days (range of 2–180 days). In the study that treated contusions with surgery, time to return to play was not included in the results.

Conclusions and relevance While thigh haematomas are common in sports, sparse literature exists regarding the appropriate timing of conservative management and when surgical intervention is warranted. On average, time to return to play following conservative management of a thigh haematoma is 29.3 days; however, it is currently unknown if operative management may provide an earlier return. This information can be used as baseline expectations when non-operative treatment is employed. If an athlete fails to return to sport at the expected time, further work-up for retained haematoma with the possible need for surgical intervention should be considered.

Level of evidence IV.

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  • Contributors MTF conceived the study. BEH, TDL and MTF designed the study. BEH and TDL acquired, interpreted and analysed the data. DBB prepared the figures. BEH, TDL, IMA, JPR and DBB prepared and revised the manuscript.

  • Competing interests MTF is a consultant for Smith and Nephew and Depuy Mitek and is a committee member of AAOS, AOSSM, AANA and ISAKOS.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement Data set is available from the corresponding author on request.

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