1
|
Graham MC, Thompson KL, Hawk GS, Fry CS, Noehren B. Muscle Fiber Cross-Sectional Area Is Associated With Quadriceps Strength and Rate of Torque Development After ACL Injury. J Strength Cond Res 2024; 38:e273-e279. [PMID: 38349361 PMCID: PMC11116075 DOI: 10.1519/jsc.0000000000004743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
ABSTRACT Graham, MC, Thompson, KL, Hawk, GS, Fry, CS, and Noehren, B. Muscle fiber cross-sectional area is associated with quadriceps strength and rate of torque development after ACL injury. J Strength Cond Res 38(6): e273-e279, 2024-The purpose of this study was to investigate the relationship between muscle fiber type-specific properties of the vastus lateralis and quadriceps muscle performance in individuals after an anterior cruciate ligament (ACL) tear. 26 subjects (22.0 ± 5.4 years) were included in this cross-sectional study, and all data were collected before ACL reconstruction. Quadriceps peak torque (QPT) and early (0-100 ms) and late (100-200 ms) rate of torque development (RTD) were obtained from maximal voluntary isometric quadriceps strength testing. Muscle fiber cross-sectional area (fCSA) and percent fiber type distribution (FT%) were evaluated through immunohistochemical analysis of a muscle biopsy. Between-limb differences in fiber characteristics were assessed using paired t-tests (with α-level 0.05). Relationships between fiber-specific properties and quadriceps muscle performance were determined using separate multiple linear regression analyses for ACL-injured and noninjured limbs. There were significant differences in fCSA between ACL-injured and noninjured limbs across all fiber types, but no differences in FT%. Type 1 fCSA, type 2a fCSA, and their interaction effect were the explanatory variables with the strongest relationship to all performance outcomes for the ACL-injured limb. The explanatory variables in the ACL-injured limb had a significant relationship to QPT and late RTD, but not early RTD. These findings suggest that QPT and late RTD are more heavily influenced by fCSA than FT% in ACL-injured limbs. This work serves as a foundation for the development of more specific rehabilitation strategies aimed at improving quadriceps muscle function before ACL reconstruction or for individuals electing nonsurgical management.
Collapse
Affiliation(s)
- Megan C Graham
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | | | - Gregory S Hawk
- Department of Statistics, University of Kentucky, Lexington, Kentucky; and
| | - Christopher S Fry
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
2
|
Cobian DG, Oppenheim ZR, Roehl TJ, Joachim MR, Heiderscheit BC. Knee Extensor Torque Steadiness and Quadriceps Activation Variability in Collegiate Athletes 4, 6, and 12 Months After ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241253843. [PMID: 38867919 PMCID: PMC11168251 DOI: 10.1177/23259671241253843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/16/2023] [Indexed: 06/14/2024] Open
Abstract
Background Quadriceps performance after anterior cruciate ligament reconstruction (ACLR) is typically characterized by peak force/torque, but the ability to generate consistent knee extensor torque may be clinically meaningful. Purpose/Hypothesis The purpose of this study was to evaluate knee extensor torque steadiness and quadriceps activation variability in collegiate athletes 4 to 12 months after ACLR. It was hypothesized that between-limb asymmetries in torque steadiness and activation variability would be observed and that steadiness would be associated with activation variability and peak knee extensor torque symmetry. Study Design Case-control study; Level of evidence, 3. Methods A total of 30 National Collegiate Athletic Association Division I athletes completed maximal voluntary isometric contractions 4, 6, and 12 months after ACLR. Torque and surface electromyography of the superficial quadriceps were recorded. Torque steadiness was calculated as the mean difference between initial and low-pass filtered torque signals and was expressed as a percentage of peak torque. Quadriceps activation variability was calculated similarly and was expressed as a percentage of peak electromyography. Linear mixed models were used to assess change in torque steadiness and activation variability over time. Associations between torque steadiness of the operated limb, activation variability, and quadriceps strength symmetry were evaluated using the Spearman correlation coefficient. Results Limb-by-time interactions were detected for torque steadiness and activation variability (P < .001), with reductions (improvements) in limb steadiness and activation variability observed with increasing time since surgery. Between-limb differences in torque steadiness and activation variability were observed at 4 and 6 months postoperatively (P < .05). Significant associations between operated limb torque steadiness and quadriceps activation variability were observed at 4 months (P < .001) and 6 months (P < .01). Torque steadiness of the operated limb was associated with peak knee extensor torque symmetry at 4 months (r S = -0.49; P < .01) and 6 months (r S = -0.49; P < .01). Conclusion In collegiate athletes, impaired knee extensor torque steadiness of the operated limb and associated abnormal quadriceps activation patterns were observed 4 to 12 months after ACLR, and the consistency of knee extensor torque production was associated with greater quadriceps strength asymmetries, particularly 4 to 6 months after surgery. Operated limb torque steadiness and activation variability improved from 4 to 12 months after ACLR. Clinical assessment of knee extensor torque steadiness after ACLR may improve prognosis and specificity of rehabilitation efforts.
Collapse
Affiliation(s)
- Daniel G. Cobian
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Doctor of Physical Therapy Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Zachary R. Oppenheim
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Tyler J. Roehl
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Doctor of Physical Therapy Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mikel R. Joachim
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Bryan C. Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
| |
Collapse
|
3
|
Dos Anjos T, Gabriel F, Vieira TD, Hopper GP, Sonnery-Cottet B. Neuromotor Treatment of Arthrogenic Muscle Inhibition After Knee Injury or Surgery. Sports Health 2024; 16:383-389. [PMID: 37102673 PMCID: PMC11025506 DOI: 10.1177/19417381231169285] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Persistent weakness of the quadriceps muscles and extension deficit after knee injuries are due to specific alterations in neural excitability - a process known as arthrogenic muscle inhibition (AMI). The effects of a novel neuromotor reprogramming (NR) treatment based on the use of proprioceptive sensations associated with motor imagery and low frequency sounds have not been studied in AMI after knee injuries. HYPOTHESIS This study aimed to assess quadriceps electromyographic (EMG) activity and the effects on extension deficits in persons with AMI who completed 1 session of NR treatment. We hypothesized that the NR session would activate the quadriceps and improve extension deficits. STUDY DESIGN Case series. LEVEL OF EVIDENCE Level 4. METHODS Between May 1, 2021 and February 28, 2022, patients who underwent knee ligament surgery or sustained a knee sprain with a deficit of >30% of the vastus medialis oblique (VMO) on EMG testing in comparison with the contralateral limb after their initial rehabilitation were included in the study. The maximal voluntary isometric contraction of the VMO measured on EMG, the knee extension deficit (distance between the heel and the table during contraction), and the simple knee value (SKV) were assessed before and immediately after completion of 1 session of NR treatment. RESULTS A total of 30 patients with a mean age of 34.6 ± 10.1 years (range, 14-50 years) were included in the study. After the NR session, VMO activation increased significantly, with a mean increase of 45% (P < 0.01). Similarly, the knee extension deficit significantly improved from 4.03 ± 0.69 cm before the treatment to 1.93 ± 0.68 after the treatment (P < 0.01). The SKV was 50 ± 5.43% before the treatment, and this increased to 67.5 ± 4.09% after the treatment (P < 0.01). CONCLUSION Our study indicates that this innovative NR method can improve VMO activation and extension deficits in patients with AMI. Therefore, this method could be considered a safe and reliable treatment modality in patients with AMI after knee injury or surgery. CLINICAL RELEVANCE This multidisciplinary treatment modality for AMI can enhance outcomes through the restoration of quadriceps neuromuscular function and subsequent reduction of extension deficits after knee trauma.
Collapse
Affiliation(s)
- Typhanie Dos Anjos
- Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, Villeurbanne Cedex, France
- ALLYANE, Lyon, France
| | | | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Graeme Philip Hopper
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| |
Collapse
|
4
|
Hjaltadóttir AÞ, Hafsteinsson D, Árnason Á, Briem K. Musculoskeletal ultrasound imaging of proximal and distal hamstrings cross sectional area in individuals with history of anterior cruciate ligament reconstruction. Physiother Theory Pract 2024; 40:487-493. [PMID: 36263941 DOI: 10.1080/09593985.2022.2135980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/25/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ultrasound (US) imaging is used by physical therapists for diagnosis and assessment of musculoskeletal injury and follow-up. PURPOSE The aim was to identify long-term effects of graft harvesting on hamstrings muscle mass among athletes who had undergone anterior cruciate ligament reconstruction (ACLR). METHODS Twenty-eight participants (ages 18-55) were recruited: 18 with history of ACLR using semitendinosus (ST) autograft and 10 healthy controls. Images of the cross-sectional area (CSA) of ST and biceps femoris (BF) were captured at 30% and 70% of the distance from the ischial tuberosity to the popliteal crease. A mixed model ANOVA was used to identify inter-limb differences in the CSA of ST and BF at each location, for each group. RESULTS Inter-limb differences were found for the CSA of ST but not BF across both locations for the ACLR group, not controls (p < .001). Within the ACLR group, ST atrophy of the injured limb was relatively greater at the distal vs. proximal location (p < .001). CONCLUSION US imaging identified selective atrophy of ST on the injured side with no compensatory hypertrophy of BF. Specific rehabilitation may influence muscle mass of medial vs. lateral hamstrings muscle groups after ACLR using a ST graft, and monitored with US imaging.
Collapse
Affiliation(s)
- Andrea Þórey Hjaltadóttir
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
- Physiotherapy Garðabær, Garðaflöt 16-18, 210 Garðabær, Iceland
- Department of orthopaedics, Landspitali University Hospital, Fossvogur, 103 Reykjavík, Iceland
| | - Daði Hafsteinsson
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
- Gáski Physiotherapy, Bolholt 8, 105 Reykjavik, Iceland
| | - Árni Árnason
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
- Gáski Physiotherapy, Bolholt 8, 105 Reykjavik, Iceland
| | - Kristín Briem
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
| |
Collapse
|
5
|
Ong MTY, Chi-Wai Man G, He X, Yu M, Lau LCM, Qiu J, Wang Q, Ho-Pak Liu J, Chi-Yin Choi B, Ng JP, Shu-Hang Yung P. Assessments of early patellofemoral joint osteoarthritis features after anterior cruciate ligament reconstruction: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:510. [PMID: 37349732 PMCID: PMC10286400 DOI: 10.1186/s12891-023-06639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Persistent anterior knee pain and subsequent patellofemoral joint (PFJ) osteoarthritis (OA) are common symptoms after anterior cruciate ligament reconstruction (ACLR). Quadriceps weakness and atrophy is also common after ACLR. This can be contributed by arthrogenic muscle inhibition and disuse, caused by joint swelling, pain, and inflammation after surgery. With quadriceps atrophy and weakness are associated with PFJ pain, this can cause further disuse exacerbating muscle atrophy. Herein, this study aims to identify early changes in musculoskeletal, functional and quality of health parameters for knee OA after 5 years of ACLR. METHODS Patients treated with arthroscopically assisted single-bundle ACLR using hamstrings graft for more than 5 years were identified and recruited from our clinic registry. Those with persistent anterior knee pain were invited back for our follow-up study. For all participants, basic clinical demography and standard knee X-ray were taken. Likewise, clinical history, symptomatology, and physical examination were performed to confirm isolated PFJ pain. Outcome measures including leg quadriceps quality using ultrasound, functional performance using pressure mat and pain using self-reported questionnaires (KOOS, Kujala and IKDC) were assessed. Interobserver reproducibility was assessed by two reviewers. RESULTS A total of 19 patients with unilateral injury who had undergone ACLR 5-years ago with persistent anterior knee pain participated in this present study. Toward the muscle quality, thinner vastus medialis and more stiffness in vastus lateralis were found in post-ACLR knees (p < 0.05). Functionally, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb with increasing knee flexion. In accordance, rectus femoris muscle stiffness in the ACLR knee was significantly correlated with pain (p < 0.05). CONCLUSION In this study, it was found that patients having higher degree of anterior knee pain were associated with higher vastus medialis muscle stiffness and thinner vastus lateralis muscle thickness. Similarly, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb leading to an abnormal PFJ loading. Taken together, this current study helped to indicate that persistent quadriceps muscle weakness is potential contributing factor to the early development of PFJ pain.
Collapse
Affiliation(s)
- Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China.
- Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
| | - Gene Chi-Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Xin He
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Mingqian Yu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Lawrence Chun-Man Lau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Jihong Qiu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Qianwen Wang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Jeremy Ho-Pak Liu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Ben Chi-Yin Choi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| | - Jonathan Patrick Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, the Chinese University of Hong Kong, 74029, Hong Kong SAR, China
| |
Collapse
|
6
|
Frouin A, Guenanten H, Le Sant G, Lacourpaille L, Liebard M, Sarcher A, McNair PJ, Ellis R, Nordez A. Validity and Reliability of 3-D Ultrasound Imaging to Measure Hamstring Muscle and Tendon Volumes. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1457-1464. [PMID: 36948893 DOI: 10.1016/j.ultrasmedbio.2023.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The validity and reliability of 3-D ultrasound (US) in estimation of muscle and tendon volume was assessed in a very limited number of muscles that can be easily immersed. The objective of the present study was to assess the validity and reliability of muscle volume measurements for all hamstring muscle heads and gracilis (GR), as well as tendon volume for the semitendinosus (ST) and GR using freehand 3-D US. METHODS Three-dimensional US acquisitions were performed for 13 participants in two distinct sessions on separate days, in addition to one session dedicated to magnetic resonance imaging (MRI). Volumes of ST, semimembranosus (SM), biceps femoris short (BFsh) and long (BFlh) heads, and GR muscles and from the tendon from semitendinosus (STtd) and gracilis (GRtd) were collected. RESULTS The bias and the 95% confidence intervals of 3-D US compared with MRI ranged from -1.9 mL (-0.8%) to 1.2 mL (1.0%) for muscle volume and from 0.01 mL (0.2%) to -0.03 mL (-2.6%) for tendon volume. For muscle volume assessed using 3-D US, intraclass correlation coefficients (ICCs) ranged from 0.98 (GR) to 1.00, and coefficients of variation (CV) from 1.1% (SM) to 3.4% (BFsh). For tendon volume, ICCs were 0.99, and CVs between 3.2% (STtd) and 3.4% (GRtd). CONCLUSION Three-dimensional US can provide a valid and reliable inter-day measurement of hamstrings and GR for both muscle and tendon volumes. In the future, this technique could be used as an outcome for strengthening interventions and potentially in clinical environments.
Collapse
Affiliation(s)
- Antoine Frouin
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France; Institut Sport Atlantique (ISA), Nantes, France
| | - Hugo Guenanten
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France
| | - Guillaume Le Sant
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France; School of Physiotherapy, IFM3R, Nantes, France
| | - Lilian Lacourpaille
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France
| | - Martin Liebard
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France; School of Physiotherapy, IFM3R, Nantes, France
| | - Aurélie Sarcher
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France
| | - Peter J McNair
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Richard Ellis
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; Active Living and Rehabilitation: Aotearoa, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Antoine Nordez
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France; Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; Institut Universitaire de France (IUF), Paris, France.
| |
Collapse
|
7
|
San Jose AT, Maniar N, Timmins RG, Beerworth K, Hampel C, Tyson N, Williams MD, Opar DA. Explosive hamstrings strength asymmetry persists despite maximal hamstring strength recovery following anterior cruciate ligament reconstruction using hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2023; 31:299-307. [PMID: 35999280 PMCID: PMC9859849 DOI: 10.1007/s00167-022-07096-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate the differences in maximal (isometric and concentric peak torque) and explosive (rate of torque development (RTD)) hamstring and quadriceps strength symmetry between males and females during early- and late-phase rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts and to determine the interaction of time and sex on maximal and explosive strength symmetry. METHODS A total of 38 female and 51 male participants were assessed during early (3-6 months post-operative) and late (7-12 months post-operative) phases of rehabilitation following ACLR. Maximal (concentric and isometric peak torque) and explosive (isometric RTD) hamstring and quadriceps strength were assessed and presented as limb symmetry index (LSI). RESULTS Maximal concentric hamstrings asymmetry (Early: 86 ± 14; Late 92 ± 13; p = 0.005) as well as maximal concentric (Early, 73 ± 15; Late 91 ± 12; p < 0.001) and explosive (Early: 82 ± 30; Late: 92 ± 25; p = 0.03) quadriceps asymmetry decreased from early to late rehabilitation. However, there were no significant changes in maximal isometric quadriceps strength and explosive isometric hamstring strength in the same time period. Females had a larger asymmetry in maximal concentric (Females: 75 ± 17; Males: 81 ± 15; p = 0.001) and explosive (Females: 81 ± 32; Males: 89 ± 25; p = 0.01) quadriceps strength than males throughout rehabilitation. There were no sex differences in maximal and explosive hamstring strength. There were no sex by time interactions for any variables. CONCLUSION Explosive hamstring strength asymmetry did not improve despite recovery of maximal hamstring strength during rehabilitation following ACLR with HT autografts. While sex did not influence strength recovery, females had larger maximal and explosive quadriceps strength asymmetry compared to males throughout rehabilitation following ACLR. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Argell T. San Jose
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia ,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC Australia
| | - Ryan G. Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia ,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC Australia
| | - Kate Beerworth
- Wakefield Sports and Exercise Medicine Clinic, Adelaide, SA Australia ,Cricket Australia, Albion, QLD Australia
| | - Chris Hampel
- Wakefield Sports and Exercise Medicine Clinic, Adelaide, SA Australia
| | - Natalie Tyson
- Wakefield Sports and Exercise Medicine Clinic, Adelaide, SA Australia
| | - Morgan D. Williams
- School of Health, Sport and Professional Practice, University of South Wales, Pontypridd, Wales UK
| | - David A. Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia ,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC Australia
| |
Collapse
|
8
|
Wang Z, Wang YT, Gao W, Zhong Y. Effects of tapering on performance in endurance athletes: A systematic review and meta-analysis. PLoS One 2023; 18:e0282838. [PMID: 37163550 PMCID: PMC10171681 DOI: 10.1371/journal.pone.0282838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/23/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE To assess the responses to taper in endurance athletes using meta-analysis. METHODS Systematic searches were conducted in China National Knowledge Infrastructure, PubMed, Web of Science, SPORTDiscus, and EMBASE databases. Standardized mean difference (SMD) and 95% confidence interval (CI) of outcome measures were calculated as effect sizes. RESULTS 14 studies were included in this meta-analysis. Significant improvements were found between pre- and post-tapering in time-trial (TT) performance (SMD = -0.45; P < 0.05) and time to exhaustion (TTE) performance (SMD = 1.28; P < 0.05). However, There were no improvements in maximal oxygen consumption ([Formula: see text]) and economy of movement (EM) (P > 0.05) between pre- and post-tapering. Further subgroup analysis showed that tapering combined with pre-taper overload training had a more significant effect on TT performance than conventional tapering (P < 0.05). A tapering strategy that reduced training volume by 41-60%, maintained training intensity and frequency, lasted ≤7 days, 8-14 days, or 15-21 days, used a progressive or step taper could significantly improve TT performance (P < 0.05). CONCLUSIONS The tapering applied in conjunction with pre-taper overload training seems to be more conducive to maximize performance gains. Current evidence suggests that a ≤21-day taper, in which training volume is progressively reduced by 41-60% without changing training intensity or frequency, is an effective tapering strategy.
Collapse
Affiliation(s)
- Zhiqiang Wang
- Sports Big-data Research Center, Wuhan Sports University, Wuhan, HuBei, China
- Hubei Sports and Health Research Center, Wuhan, HuBei, China
| | - Yong Tai Wang
- Rochester Institute of Technology, College of Health Sciences and Technology, New York, Rochester, United States of America
| | - Weifeng Gao
- Sports Big-data Research Center, Wuhan Sports University, Wuhan, HuBei, China
| | - Yaping Zhong
- Sports Big-data Research Center, Wuhan Sports University, Wuhan, HuBei, China
- Hubei Sports and Health Research Center, Wuhan, HuBei, China
| |
Collapse
|
9
|
du Moulin W, Bourne M, Diamond LE, Konrath J, Vertullo C, Lloyd D, Saxby DJ. Shape differences in the semitendinosus following tendon harvesting for anterior cruciate ligament reconstruction. J Orthop Res 2023; 41:44-53. [PMID: 35434842 PMCID: PMC10084140 DOI: 10.1002/jor.25337] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/12/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023]
Abstract
Following hamstring autograft anterior cruciate ligament reconstruction (ACLR), muscle length, cross-sectional area, and volume are reduced. However, these discrete measures of morphology do not account for complex three-dimensional muscle shape. The primary aim of this study was to determine between-limb semitendinosus (ST) shape and regional morphology differences in young adults following tendon harvest for ACLR and to compare these differences with those in healthy controls. In this cross-sectional study, magnetic resonance imaging was performed on 18 individuals with unilateral ACLR and 18 healthy controls. Bilaterally, ST muscles were segmented, and shape differences assessed between limbs and compared between groups using Jaccard index (0-1) and Hausdorff distance (mm). Length (cm), peak cross-sectional area (cm2 ), and volume (cm3 ) were measured for the entire muscle and proximal, middle, and distal regions, and compared between limbs and groups. Compared to healthy controls, the ACLR group had significantly (p < 0.001, Cohen's d = -2.33) lower bilateral ST shape similarity and shape deviation was significantly (p < 0.001, d = 2.12) greater. Shape deviation was greatest within the distal region of the ACLR (Hausdorff: 23.1 ± 8.68 mm). Compared to both the uninjured contralateral limb and healthy controls, deficits in peak cross-sectional area and volume in ACLR group were largest in proximal (p < 0.001, d = -2.52 to -1.28) and middle (p < 0.001, d = -1.81 to -1.04) regions of the ST. Overall, shape analysis provides unique insight into regional adaptations in ST morphology post-ACLR. Findings highlight morphological features in distal ST not identified by traditional discrete morphology measures. Clinical significance: Following ACLR, risk of a secondary knee or primary hamstring injury has been reported to be between 2-to-5 times greater compared to those without ACLR. Change in semitendinosus (ST) shape following ACLR may affect force transmission and distribution within the hamstrings and might contribute to persistent deficits in knee flexor and internal rotator strength.
Collapse
Affiliation(s)
- William du Moulin
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew Bourne
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jason Konrath
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Principia Technology, Crawley, Western Australia, Australia
| | - Christopher Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Knee Research Australia, Gold Coast, Queensland, Australia
| | - David Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
10
|
Cleary CJ, Weir JP, Vopat BG, Herda AA. Evaluation of raw segmental bioelectrical impedance variables throughout anterior cruciate ligament reconstruction rehabilitation. Physiol Meas 2022; 43. [PMID: 36575155 DOI: 10.1088/1361-6579/acaa87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Background.Raw bioelectrical impedance analysis (BIA) variables are related to physical function in healthy and diseased populations. Therefore, BIA may be an insightful, noninvasive method of assessment to track following anterior cruciate ligament reconstruction (ACLR).Objectives.Evaluate phase angle, reactance and impedance at 50 kHz (PhA50, Xc50, andZ50, respectively) in the operative (OP) and non-operative (NOP) limbs during ACLR rehabilitation.Approach.Seventeen patient (12 M, 5 F; 18.8 ± 4.8 years) clinic reports were evaluated prior to ACLR (PRE), two- (2 W), six- (6 W), and twelve-weeks (12 W) post-ACLR and at return to sport testing (RTS).Setting.All observations occurred during the participant's physical therapy visits.Measurements.A multi-frequency BIA device measured segmental PhA, Xc, andZ. Linear mixed effects models were used to assess any leg and time interaction and changes over leg and time, independently. Any interactions or main effects were considered significant atp< 0.05.Main results.Significant legxtime interactions were observed for each variable. PhA50and Xc50of NOP were higher (p< 0.001) than OP at each time point by an average of by 0.9° and 4.9 Ω, respectively. In OP, PhA50and Xc50decreased from PRE to 2 W and increased from 6 to 12 W and 12 W to RTS (p< 0.01, for all). At RTS, PhA50and Xc50were similar to PRE in OP (p> 0.05). ForZ50, the OP leg did not change over time (p> 0.05).Z50was greater in NOP at 2 and 6 W (p< 0.01, for both). There were differences in PhA50in NOP between PRE and 6 W and from 6 W to RTS (p< 0.05 for both). Xc50did not change (p> 0.05), andZ50PRE was lower than at 2 W (p< 0.05).Significance.A multi-frequency BIA device can detect changes in segmental BIA variables following ACLR.
Collapse
Affiliation(s)
- Christopher J Cleary
- Department of Health, Sport, and Exercise Sciences, University of Kansas Edwards Campus, Overland Park, Kansas, United States of America
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Sciences, University of Kansas Lawrence Campus, Lawrence, Kansas, United States of America
| | - Bryan G Vopat
- University of Kansas Medical Center, Department of Orthopedic Surgery and Sports Medicine, Kansas City, Kansas, United States of America
| | - Ashley A Herda
- Department of Health, Sport, and Exercise Sciences, University of Kansas Edwards Campus, Overland Park, Kansas, United States of America
| |
Collapse
|
11
|
Norte GE, Cousins M, Hogarth DA, Knaus KR, Slater LV, Blemker SS, Hart JM. Personalized volumetric assessment of lower body muscles in patients with knee injuries: A descriptive case series. Knee 2022; 39:38-49. [PMID: 36126493 DOI: 10.1016/j.knee.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with knee joint pathology present with variable muscular responses across the muscles of the lower limb and pelvis. Conventional approaches to characterizing muscle function are limited to gross strength assessments that may overlook subtle changes both in the thigh, hip and shank musculature. PURPOSE To describe individualized patterns of lower extremity muscle volumes in patients with knee pathologies. METHODS This was a retrospective case series performed in a University medical center. Nine patients diagnosed with meniscus tear recommended to undergo meniscectomy volunteered. Participants underwent 3.0 Tesla magnetic resonance imaging (MRI) of the lower extremities. Thirty-five MRI-derived muscle volumes were compared between limbs and expressed as percentage asymmetry. For additional context, z-scores were also calculated for mass- and height-normalized muscles and pre-determined muscle groupings relative to a normative database. RESULTS There were no consistent patterns observed when considering between-limb asymmetries among all patients. The ankle musculature (dorsiflexors, plantar flexors, and invertors) was the only muscle group to be consistently smaller than normal for all patients, with the psoas major and flexor hallucis longus being the only individual muscles. The severity or chronicity of injury and presence of surgical intervention did not appear to have a clear effect on muscle volumes. CONCLUSION Patients with a history of meniscal pathology demonstrate inconsistent patterns of lower extremity muscle volumes about the hip, knee, and ankle between limbs and in comparison to uninjured individuals. These data support the need for individualized assessment and intervention in this population.
Collapse
Affiliation(s)
- Grant E Norte
- Department of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, United States.
| | | | - Danielle A Hogarth
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States
| | - Katherine R Knaus
- Department of Bioengineering, University of California at San Diego, San Diego, CA, United States
| | - Lindsay V Slater
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Silvia S Blemker
- Springbok Analytics, Charlottesville, VA, United States; Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States; Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States; Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, United States
| | - Joseph M Hart
- Springbok Analytics, Charlottesville, VA, United States; Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
12
|
Time, graft, sex, geographic location, and isokinetic speed influence the degree of quadriceps weakness after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3367-3376. [PMID: 35224649 DOI: 10.1007/s00167-022-06906-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Although quadriceps weakness after ACL reconstruction (ACLR) is well documented, the magnitude of reported weakness varies considerably. Such variation raises the possibility that certain patients may be more susceptible to quadriceps weakness after ACLR. This meta-analysis identified factors explaining between-study variability in quadriceps weakness post-ACLR. METHODS Studies between 2010 and 2020 were screened for the following criteria: human subjects, unilateral ACLR, and strength reported both for the ACLR leg and the uninjured or healthy-control leg. 122 studies met the criteria, resulting in 303 and 152 Cohen's d effect sizes (ESs) comparing ACLR legs to uninjured legs (a total of 4135 ACLR subjects) and to healthy controls (a total of 1,507 ACLR subjects vs. 1-193 healthy controls), respectively. Factors (time, graft, sex, activity, mass/height, geographic area, concomitant injury, and type of strength testing) that may affect study ES were examined. RESULTS Meta-regressions indicated an association between time post-ACLR and study ESs (P < 0.001) and predicted full recovery (ES = 0) to occur at 54-59 months post-ACLR. When compared to uninjured legs, patients with patellar tendon autografts had greater deficits than studies using hamstring tendon autografts (P = 0.023). When compared to uninjured legs, studies including only males reported greater deficits than studies combining males and females (P = 0.045); whereas when compared to healthy controls, studies combining males and females reported greater deficits than studies with males (P = 0.013). When compared to controls, studies from USA reported greater deficits than studies from Europe (P = 0.003). Increased isokinetic-testing speed was associated with smaller deficits (P ≤ 0.025). Less than 25% of patients achieved a between-limb symmetry in quadriceps strength > 90% between 6 and 12 months post-ACLR. CONCLUSION Time post-surgery, graft, sex, geographic location, and isokinetic speed influenced the magnitude of post-ACLR quadriceps weakness. Patients with patellar tendon autografts demonstrated greater between-limb asymmetry in quadriceps strength, while female strength deficits were underestimated to a greater extent. A slower isokinetic speed provided a more sensitive assessment of quadriceps strength post-ACLR. The overwhelming majority of patients were returning to sport with significantly impaired quadriceps strength. LEVEL OF EVIDENCE III.
Collapse
|
13
|
Beynnon BD, Pius AK, Tourville TW, Endres NK, Failla MJ, Choquette RH, DeSarno M, Toth MJ. The Duration of Thigh Tourniquet Use Associated With Anterior Cruciate Ligament Reconstruction Does Not Produce Cellular-Level Contractile Dysfunction of the Quadriceps Muscle at 3 Weeks After Surgery. Am J Sports Med 2022; 50:2925-2934. [PMID: 35980007 DOI: 10.1177/03635465221115823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) trauma and ACL reconstruction (ACLR) are associated with the loss of strength and function of the muscles that span the knee joint. The underlying mechanism associated with this is not completely understood. PURPOSE To determine whether the duration of tourniquet use during ACLR has an effect on knee extensor muscle contractile function and size at the cellular (ie, fiber) level 3 weeks after surgery and at the whole-muscle level at 6 months after surgery. STUDY DESIGN Descriptive laboratory study and case series; Level of evidence, 4. METHODS Study participants sustained an acute, first-time ACL injury. All participants underwent ACLR with the use of a tourniquet placed in a standardized location on the thigh; the tourniquet was inflated (pressure range, 250-275 mm Hg), and the time of tourniquet use during surgery was documented. Participants were evaluated 1 week before surgery (to measure patient function, strength, and subjective outcome with the Knee injury and Osteoarthritis Outcome Score [KOOS] and International Knee Documentation Committee [IKDC] score), at 3 weeks after ACLR surgery (to obtain muscle biopsy specimens of the vastus lateralis and assess muscle fiber cross-sectional area, contractile function, and mitochondrial content and morphometry), and at 6 months after ACLR (to evaluate patient function, strength, and subjective outcomes via KOOS and IKDC scores). Data were acquired on both the injured/surgical limb and the contralateral, normal side to facilitate the use of a within-subjects study design. Results are based on additional analysis of data acquired from previous research that had common entry criteria, treatments, and follow-up protocols. RESULTS At 3 weeks after ACLR, the duration of tourniquet use at the time of surgery did not explain the variation in single-muscle fiber contractile function or cross-sectional area (myosin heavy chain [MHC] I and II fibers) or subsarcolemmal and intermyofibrillar mitochondrial content or morphometry. At 6 months after ACLR, the duration of tourniquet use was not associated with the peak isometric and isokinetic torque measurements, patient function, or patient-reported outcomes. CONCLUSION The duration of tourniquet use at the time of ACLR surgery did not explain variation in muscle fiber size, contractile function, or mitochondrial content at 3 weeks after surgery or strength of the quadriceps musculature or patient-reported function or quality of life at 6-month follow-up.
Collapse
Affiliation(s)
- Bruce D Beynnon
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA.,Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Alexa K Pius
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Timothy W Tourville
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Nathan K Endres
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mathew J Failla
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Rebecca H Choquette
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mike DeSarno
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Michael J Toth
- Department Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.,Department of Molecular Physiology and Biophysics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| |
Collapse
|
14
|
Tim-Yun Ong M, Fu SC, Mok SW, Franco-Obregón A, Lok-Sze Yam S, Shu-Hang Yung P. Persistent quadriceps muscle atrophy after anterior cruciate ligament reconstruction is associated with alterations in exercise-induced myokine production. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 29:35-42. [PMID: 35847192 PMCID: PMC9263390 DOI: 10.1016/j.asmart.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/05/2022] [Accepted: 05/18/2022] [Indexed: 01/03/2023] Open
Abstract
Purpose Persistent quadriceps muscle atrophy is observed in a subset of patients following anterior cruciate ligament reconstruction (ACLR) despite the completion of comprehensive rehabilitation. Critically, quadriceps muscle atrophy correlates with muscle weakness and quadriceps strength deficits. The aim of this study was to examine the effect of resistance exercise on myokine levels and muscle atrophy status in ACLR patients with persistent quadriceps muscle atrophy. Methods Sixteen participants between the ages of 18–39 with a Tegner score of >6 and who had undergone ACLR with hamstring graft were recruited for the study. Quadriceps muscle thicknesses were ascertained by ultrasonography and isokinetic strength assessments were made prior to commencing a single bout of resistance exercise training (RET). Blood samples were taken before and after RET and assayed for myokine expression. Self-reported activity level and knee function questionnaires were completed and recorded. Results Clustering by quadriceps muscle size measurements created a non-atrophy group of 9 subjects and an atrophy group of 7 subjects. There were no significant between-group differences in anthropometric measurements, time post operation and knee function questionnaires, but the atrophic group comprised of patients with lower pre-injury sporting levels. The atrophy group exhibited significant lower side-to-side muscle thickness ratios and a decreasing trend in quadriceps strength deficits. Serum brain-derived neurotrophic factor (BDNF) was up-regulated in response to RET in non-atrophy group, but a negative fold change was detected in the atrophy group. Conclusion The dysregulation in myokines plays an important role in patients failing to regain muscle mass after ACLR leading to persistent quadriceps muscle atrophy, which may potentiate greater strength deficits and poor functional recovery.
Collapse
Affiliation(s)
- Michael Tim-Yun Ong
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sai-Chuen Fu
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sze-Wing Mok
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Alfredo Franco-Obregón
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,BioIonic Currents Electromagnetic Pulsing Systems (BICEPS) Laboratory, National University of Singapore, Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Institute for Health Innovation and Technology, iHealthtech, National University of Singapore, Singapore
| | - Stacy Lok-Sze Yam
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
15
|
Zhang H, Chen G. Comment on "Lower Limb Muscle Size After Anterior Cruciate Ligament Injury: A Systematic Review and Meta‑Analysis". Sports Med 2022; 52:1205. [PMID: 34674185 DOI: 10.1007/s40279-021-01576-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Han Zhang
- Department of Joint Surgery, Shanxian Central Hospital, Heze, 274000, China
| | - Guanhong Chen
- Department of Joint Surgery, Shanxian Central Hospital, Heze, 274000, China.
| |
Collapse
|
16
|
Authors' Response to Comment on "Lower Limb Muscle Size After Anterior Cruciate Ligament Injury: A Systematic Review and Meta‑analysis". Sports Med 2022; 52:1207-1209. [PMID: 34674186 DOI: 10.1007/s40279-021-01577-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 01/12/2023]
|
17
|
Tourville TW, Voigt TB, Choquette RH, Failla MJ, Endres NK, Slauterbeck JR, Beynnon BD, Toth MJ. Skeletal muscle cellular contractile dysfunction after anterior cruciate ligament reconstruction contributes to quadriceps weakness at 6-month follow-up. J Orthop Res 2022; 40:727-737. [PMID: 33969521 PMCID: PMC8578585 DOI: 10.1002/jor.25065] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Muscle dysfunction following anterior cruciate ligament reconstruction (ACLR) may evolve from alterations in muscle contractility at the myofilament protein level. Using a prospective, within-subject case-control design, we evaluated cellular-level contractility, cross-sectional area (CSA), and myosin heavy chain (MHC) isoform expression on single muscle fibers 3 weeks post ACLR, and evaluated their relationship to whole muscle strength and patient-oriented outcomes 6 months post operation. Biopsies of the vastus lateralis were performed 3 weeks post ACLR in 11 subjects (5 females, mean age ± SD = 24.7 ± 6.5 years, height = 172.7 ± 8.2 cm, mass = 75.7 ± 12.5 kg) following first-time ACL rupture and whole muscle strength and self-reported pain, function, and quality of life assessed 6 months post ACLR. At 3 weeks post ACLR, force production was reduced (p < 0.01) in MHC I (-36%) and IIA (-48%) fibers compared with the non-injured leg. When force production was expressed relative to CSA to account for fiber atrophy, reductions remained in MHC IIA fibers (-40%; p < 0.001), but MHC I fibers showed only a trend toward being lower (-13%; p = 0.09). Finally, skeletal muscle fiber functional deficits at 3 weeks post ACLR were associated with whole muscle weakness and less favorable patient-reported outcomes at 6-month follow-up. Thus, ACLR promotes early cellular contractile dysfunction that may contribute to decreased whole muscle strength and patient function, and increased patient-reported symptoms, at 6-month follow-up.
Collapse
Affiliation(s)
- Timothy W. Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.,Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Thomas B. Voigt
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Rebecca H. Choquette
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Mathew J. Failla
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Nathan K. Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - James R. Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Michael J. Toth
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA,Department of Medicine, University of Vermont, Burlington, VT, USA,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT, USA
| |
Collapse
|
18
|
Arthrogenic Muscle Inhibition Following Anterior Cruciate Ligament Injury. J Sport Rehabil 2022; 31:694-706. [PMID: 35168201 DOI: 10.1123/jsr.2021-0128] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
Abstract
Arthrogenic muscle inhibition (AMI) is a common impairment in individuals who sustain an anterior cruciate ligament (ACL) injury. The AMI causes decreased muscle activation, which impairs muscle strength, leading to aberrant movement biomechanics. The AMI is often resistant to traditional rehabilitation techniques, which leads to persistent neuromuscular deficits following ACL reconstruction. To better treat AMI following ACL injury and ACL reconstruction, it is important to understand the specific neural pathways involved in AMI pathogenesis, as well as the changes in muscle function that may impact movement biomechanics and long-term structural alterations to joint tissue. Overall, AMI is a critical factor that limits optimal rehabilitation outcomes following ACL injury and ACL reconstruction. This review discusses the current understanding of the: (1) neural pathways involved in the AMI pathogenesis following ACL injury; (2) consequence of AMI on muscle function, joint biomechanics, and patient function; and (3) development of posttraumatic osteoarthritis. Finally, the authors review the evidence for interventions specifically used to target AMI following ACL injury.
Collapse
|
19
|
Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation. J Sport Rehabil 2021; 31:717-735. [PMID: 34883466 DOI: 10.1123/jsr.2021-0139] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-traumatic muscular impairments are concerning, and suggest that interventions for AMI are not being successfully integrated into clinical practice. OBJECTIVES To highlight the clinical relevance of AMI, provide updated evidence for the use of clinically accessible therapeutic adjuncts to treat AMI, and discuss the known or theoretical mechanisms for these interventions. EVIDENCE ACQUISITION PubMed and Web of Science electronic databases were searched for articles that investigated the effectiveness or efficacy of interventions to treat outcomes relevant to AMI. EVIDENCE SYNTHESIS 122 articles that investigated an intervention used to treat AMI among individuals with pathology or simulated pathology were retrieved from 1986 to 2021. Additional articles among uninjured individuals were considered when discussing mechanisms of effect. CONCLUSION AMI contributes to the characteristic muscular impairments observed in patients recovering from joint injuries. If left unresolved, AMI impedes short-term recovery and threatens patients' long-term joint health and well-being. Growing evidence supports the use of neuromodulatory strategies to facilitate muscle recovery over the course of rehabilitation. Interventions should be individualized to meet the needs of the patient through shared clinician-patient decision-making. At a minimum, we propose to keep the treatment approach simple by attempting to resolve inflammation, pain, and effusion early following injury.
Collapse
|
20
|
Palmieri-Smith RM, Garcia SA, Rodriguez KM, Krishnan C. Electrically Evoked Torque at Rest is Strongly Related to Quadriceps Muscle Size in Individuals with Anterior Cruciate Ligament Reconstruction. MEASUREMENT IN PHYSICAL EDUCATION AND EXERCISE SCIENCE 2021; 26:199-206. [PMID: 36060895 PMCID: PMC9439261 DOI: 10.1080/1091367x.2021.2005602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Electrically evoked torque at rest (i.e., the torque produced from supramaximal stimul applied to a resting muscle) has been shown to be related to muscle size in healthy adults, but this relationship has not been evaluated in pathological populations where atrophy is present. This study aimed to evaluate the relationship between the electrically evoked torque at rest and vastus lateralis cross-sectional area (CSA) in individuals with anterior cruciate ligament (ACL) reconstruction. Eighteen individuals with ACL reconstruction participated. Quadriceps electrically evoked torque at rest was elicited bilaterally via sex-specific, standardized supramaximal triplet stimulations. Vastus lateralis CSA was measured at 50% of thigh length using ultrasound. Pearson's r and partial correlations were used to evaluate associations between outcomes. Evoked torque at rest was positively associated with vastus lateralis CSA in the ACL reconstructed limb (r=0.865, partial r=0.816, P<0.01), non-reconstructed limb (r=0.628, partial r=0.575, P<0.05), and side-to-side ratios (r=0.670, partial r=0.659, P<0.01). These results indicate that electrically evoked torque at rest may indirectly assess side-to-side differences in quadriceps muscle size after ACL reconstruction.
Collapse
Affiliation(s)
- Riann M. Palmieri-Smith
- School of Kinesiology, University of Michigan; Ann Arbor, MI
- Orthopedic Rehabilitation and Biomechanics Laboratory, University of Michigan, Ann Arbor, MI
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Steven A Garcia
- Orthopedic Rehabilitation and Biomechanics Laboratory, University of Michigan, Ann Arbor, MI
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Kazandra M. Rodriguez
- Orthopedic Rehabilitation and Biomechanics Laboratory, University of Michigan, Ann Arbor, MI
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, University of Michigan; Ann Arbor, MI
- Neuromuscular and Rehabilitation Robotics Laboratory, University of Michigan; Ann Arbor, MI
- Robotics Institute, University of Michigan, Ann Arbor, MI
| |
Collapse
|
21
|
Dutaillis B, Timmins RG, Lathlean TJH. Quadriceps muscle size changes following exercise in anterior cruciate ligament reconstructed limbs: A systematic review. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Benjamin Dutaillis
- Exercise and Sports Science, School of Science and Technology The University of New England Armidale NSW Australia
| | - Ryan G. Timmins
- School of Behavioural and Health Sciences Australian Catholic University Melbourne Vic. Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre Australian Catholic University Fitzroy Vic. Australia
| | - Timothy J. H. Lathlean
- Exercise and Sports Science, School of Science and Technology The University of New England Armidale NSW Australia
- Flinders Health and Medical Research Institute (FMHRI) Flinders University Bedford Park SA Australia
| |
Collapse
|