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. 2015 Oct 30;50(4):205–208. doi: 10.1136/bjsports-2015-095136

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Tendon failure. (A) Coronal fat suppressed image of a 23-year-old footballer with sudden onset of anterior thigh pain when sprinting for the ball, demonstrates myofibril tearing (solid arrow) on either side of the intramuscular tendon rachis of the rectus femoris to create a feather-like appearance. The intramuscular tendon is intact but has a wavy contour (open arrow) suggesting the rachis has begun to fail.(B) Coronal fat-saturated sequence of a 19-year-old footballer with sudden hamstring failure when running, demonstrates failure of the proximal intramuscular tendon rachis (arrow) with tendon strands unravelling. However, given that the tendon remained broadly contiguous (with no tendon gap), the athlete was treated in a conservative manner with return to competition 6 weeks later. (C) Axial fat-suppressed image demonstrates longitudinal delamination and splitting of the biceps femoris intramuscular tendon (open arrow). However, no gap is seen. Note haemorrhage surrounding the muscle (solid arrows).(D) A 29-year-old footballer with a history of a rectus femoris strain returns to competition only to sustain another injury. On examination, there is a palpable defect in the anterior thigh at the junction of the middle and distal thirds of the thigh. Coronal fat suppressed image demonstrates failure of the intramuscular tendon rachis of rectus femoris with tendon retraction filled with blood products to create a ‘bull's eye’ or ‘target’ lesion (arrow). Note the torn adjacent muscle fibres with no connective scaffold to hang on to. The defect will take some time for granulation tissue to fill, and indeed may never completely do so, leaving the athlete with a residual defect.