Sports Medicine
Tyler Hwang, BS
Medical Student
Georgetown University School of Medicine
Bethesda, Maryland, United States
Shawn Joshi, MD, PhD
PGY-3
Spaulding Rehabilitation Hospital/Harvard Medical School
Boston, Massachusetts, United States
Ashwin Babu, MD
Attending Physician, Sports Medicine
Spaulding Rehabilitation Hospital/Massachusetts General Hospital
n/a, Massachusetts, United States
Tyler Hwang, N/A
Georgetown University School of Medicine
Bethesda, Maryland, United States
Post-traumatic myositis ossificans of the right quadriceps following a lacrosse-related contusion in a healthy 17-year-old male.
Case Description:
A high school male athlete with no medical history presented in June 2025 with acute pain and restricted knee flexion following direct blunt trauma to the anterior right thigh during a lacrosse game. Initial radiographs revealed mid-lateral thigh calcifications without fracture. At 2 weeks, right knee exam was notable for full extension, knee flexion to 110o, and anterolateral quad tenderness. Follow-up x-rays demonstrated evolving calcifications along the femoral shaft, and ultrasound showed an incomplete quadriceps tear with surrounding fluid consolidation consistent with traumatic hematoma. Hematoma aspiration was discussed but deferred due to developing ossifications and bleeding risk. Conservative management with rest, ice, and NSAIDs was recommended. By 4-6 weeks, the patient regained full, pain-free ROM in his right quadriceps, and ultrasound continued to reveal maturing foci of ossification. Although a mild quad strength deficit persisted, he began a return-to-run program followed by a supervised strengthening program under physical therapy guidance.
Discussions:
Myositis ossificans is a benign ossifying lesion that typically develops after significant muscle contusion or hematoma. Early management focuses on minimizing hematoma development and inflammation. Studies suggest that aspiration may reduce fibro-osseous transformation and improve patient ROM, however, evidence remains mixed. While aspiration may provide benefit in the early stages of heterotopic bone formation, it offers limited benefit in already radiographically evident calcification while increasing risk of rebleeding, infection, and mechanical disruption. This case underscores the importance of individualized risk-benefit stratification when considering aspiration in patient candidates.
Conclusions:
In patients with post-traumatic myositis ossificans, hematoma aspiration may be most beneficial immediately following injury and prior to heterotopic bone morphogenesis. Conservative management remains favored in the setting of developing ossification and absence of neurovascular compromise.
