Treatment of Full Thickness Gracilis Muscle Tear
Conservative management with relative rest, eccentric exercise programs, NSAIDs, and physical therapy is the recommended treatment for full thickness gracilis muscle tears, with excellent prognosis for return to full activity within 6 weeks. 1, 2
Initial Management Approach
Begin with conservative treatment for all full thickness gracilis tears unless there are exceptional circumstances. 1 The evidence strongly supports non-operative management as first-line therapy, analogous to other muscle-tendon injuries.
Immediate Phase (First 1-2 Weeks)
- Relative rest is essential—avoid complete immobilization as tensile loading stimulates proper healing and prevents muscular atrophy 1
- NSAIDs for pain management and inflammation control 1
- Cryotherapy to reduce acute inflammation 1
- Avoid activities that reproduce the injury mechanism (typically hip adduction with internal rotation) 2
Rehabilitation Phase (Weeks 2-6)
- Eccentric exercise programs are the cornerstone of treatment, promoting proper collagen alignment and tensile strength 1
- Progressive stretching exercises to maintain flexibility and prevent contracture 1
- Gradual return to sport-specific activities as pain allows 2
Expected Outcomes
Full recovery occurs within 6 weeks in elite athletes with isolated gracilis tears. 2 A case series of 7 elite athletes (dancers, soccer players, martial artists) demonstrated complete return to full performance averaging 35.6 days (range 20-42 days) after injury. 2
One equestrian case showed significant improvement and return to horseback riding at 12 weeks after a high-grade partial thickness tear. 3
Critical Pitfalls to Avoid
Do not use corticosteroid injections into the muscle or tendon substance. 1 Corticosteroids have deleterious effects when injected directly into tendons and should be limited to single injections for short-term relief only in adjacent bursal structures (such as pes anserine bursa if inflamed). 1, 3
Avoid repeated corticosteroid injections as they may predispose to muscle injury and impair healing. 1, 3 One case report documented gracilis tear potentially related to repetitive interventional procedures in the region. 3
Do not immobilize completely—this causes muscular atrophy and deconditioning, impairing recovery. 1
Diagnostic Confirmation
- Ultrasound is the preferred imaging modality for gracilis tears, showing the lesion location (typically at the muscle-tendon junction in the proximal-middle third of the thigh) and extent 2
- MRI can be used if ultrasound is inconclusive or to evaluate for complications 3
- Lesions are typically grade 2 (partial discontinuity) with average dimensions of 17.1 × 23.7 mm 2
Surgical Considerations
Surgery is not indicated for isolated gracilis muscle tears. There is no evidence supporting surgical intervention for this injury pattern. The gracilis muscle has been successfully used as a flap for other surgical procedures 4, but primary repair of acute tears is not performed given excellent outcomes with conservative management. 2, 5
Monitoring for Complications
Watch for development of fibrotic myopathy (approximately 3 months post-injury), which can cause persistent gait deficits and may require surgical transection of fibrous bands if conservative measures fail. 6 However, this complication is rare in humans and primarily reported in equine literature.