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Çiftçi R, Kurtoğlu A, Çar B, Karavaş E, Eken Ö, Söyler M, Ardigò LP, Nobari H. Exploring the quadriceps muscle architecture variations in various sports disciplines: a comparative analysis of football, taekwondo, and athletics. J Sports Med Phys Fitness 2024; 64:728-736. [PMID: 38470013 DOI: 10.23736/s0022-4707.24.15382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND The purpose of this study was to comprehensively investigate and compare the architecture of the quadriceps muscle in football, taekwondo, and athletics, shedding light on potential differences and providing valuable insights for athletic training and performance enhancement. METHODS Thirty-five athletes (football[N.]=14. [7 women, 7 men]; taekwondo [N.]=11. [6 women, 5 men]; athletics [N.]=10. [5 women, 5 men]) aged 17-21 years participated in the study. After participant demographic data were collected, 2D real-time B-mode ultrasound (USG) and right (R) and left (L) leg quadriceps muscle group rectus femoris (RF), vastus intermedius (VI), vastus lateralis, pennation angle (PA), RF cross-sectional area (CSA), and subcutaneous fat thickness were determined. RESULTS In the study, in female athletes, R-RF+VI (P=0.04, ES:4.34), R-VI (P=0.01, ES: 6.1), R-RF: (P=0.009, ES: 7.9), R-CSA (P=0.04, ES: 5.2), L-RF (P=0.002, ES: 10.4) and L-CSA (P=0.007, ES: 7.7) significant differences were found in favor of the Football group. In male athletes, R-CSA (P=0.004, ES: 9.05), L-RF (P=0.05, ES: 3.5) and L-SFT (P=0.00, ES: 13.6), there was a significant difference in favor of the Football group. L-PA (P=0.009, ES: 6.2). L-PA (P=0.009, ES: 6.2) was significantly higher in the male Taekwondo group. CONCLUSIONS Our research findings show that there is a significant relationship between the type of exercise performed and the structural differences observed in the quadriceps muscle. Consequently, it is highly recommended to consider the outcomes of our study for enhancing the efficacy of training programs in the domains of football, taekwondo, and athletics.
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Affiliation(s)
- Rukiye Çiftçi
- Department of Anatomy, Medical Faculty, Gaziantep Islam Science and Technology University, Gaziantep, Türkiye
| | - Ahmet Kurtoğlu
- Department of Coaching Education, Faculty of Sport Science, Bandırma Onyedi Eylul University, Bandırma, Türkiye
| | - Bekir Çar
- Faculty of Sport Science, Bandırma Onyedi Eylul University, Bandırma, Türkiye
| | - Erdal Karavaş
- Department of Radiology, Medical Faculty, Bandırma Onyedi Eylul University, Bandırma, Türkiye
| | - Özgür Eken
- Department of Physical Education and Sport Teaching, Inonu University, Malatya, Türkiye
| | - Mehmet Söyler
- Department of Private Security and Protection, Vocational School of Social Sciences, Çankırı Karatekin University, Çankırı, Türkiye
| | - Luca P Ardigò
- Department of Teacher Education, NLA University College, Oslo, Norway -
| | - Hadi Nobari
- Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
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White MS, Ogier AC, Chenevert TL, Zucker E, Stoneback L, Michel CP, Palmieri-Smith RM, Lepley LK. Beyond weakness: Exploring intramuscular fat and quadriceps atrophy in ACLR recovery. J Orthop Res 2024. [PMID: 38824275 DOI: 10.1002/jor.25910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/19/2024] [Accepted: 05/16/2024] [Indexed: 06/03/2024]
Abstract
Muscle weakness following anterior cruciate ligament reconstruction (ACLR) increases the risk of posttraumatic osteoarthritis (OA). However, focusing solely on muscle weakness overlooks other aspects like muscle composition, which could hinder strength recovery. Intramuscular fat is a non-contractile element linked to joint degeneration in idiopathic OA, but its role post-ACLR has not been thoroughly investigated. To bridge this gap, we aimed to characterize quadriceps volume and intramuscular fat in participants with ACLR (male/female = 15/9, age = 22.8 ± 3.6 years, body mass index [BMI] = 23.2 ± 1.9, time since surgery = 3.3 ± 0.9 years) and in controls (male/female = 14/10, age = 22.0 ± 3.1 years, BMI = 23.3 ± 2.6) while also exploring the associations between intramuscular fat and muscle volume with isometric strength. Linear mixed effects models assessed (I) muscle volume, (II) intramuscular fat, and (III) strength between limbs (ACLR vs. contralateral vs. control). Regression analyses were run to determine if intramuscular fat or volume were associated with quadriceps strength. The ACLR limb was 8%-11% smaller than the contralateral limb (p < 0.05). No between-limb differences in intramuscular fat were observed (p 0.091-0.997). Muscle volume but not intramuscular fat was associated with strength in the ACLR and control limbs (p < 0.001-0.002). We demonstrate that intramuscular fat does not appear to be an additional source of quadriceps dysfunction following ACLR and that muscle size only explains some of the variance in muscle strength.
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Affiliation(s)
- McKenzie S White
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Augustin C Ogier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Zucker
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Luke Stoneback
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Lindsey K Lepley
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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Johnston CD, Dewig DR, Pietrosimone B, Padua D, Ryan ED, Hart J, Spang J, Blackburn T. Longitudinal Changes in Quadriceps Morphology over the First 3 Months after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:933-941. [PMID: 38109204 DOI: 10.1249/mss.0000000000003359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
PURPOSE Neuromuscular deficits and atrophy after anterior cruciate ligament reconstruction (ACLR) may be accompanied by changes in muscle composition and poor quadriceps muscle quality (QMQ). Quadriceps atrophy occurs after ACLR but improves within the first three postoperative months, yet this hypertrophy could be attributable to increases in noncontractile tissue (i.e., poor QMQ). The purposes of this study were to evaluate changes in QMQ after ACLR and to determine if changes in QMQ and cross-sectional area (CSA) occur in parallel or independently. METHODS A longitudinal prospective cohort design was implemented to evaluate QMQ and CSA in 20 individuals with ACLR and 12 healthy controls. Participants completed three testing sessions (baseline/presurgery, 1 month, and 3 months) during which ultrasound images were obtained from the vastus lateralis (VL) and rectus femoris (RF). QMQ was calculated as the echo intensity (EI) of each image, with high EI representing poorer QMQ. Anatomical CSA was also obtained from each image. RESULTS RF and VL EI were greater at 1 and 3 months in the ACLR limb compared with baseline and the contralateral limb and did not change between 1 and 3 months. VL and RF CSA in the ACLR limb were smaller at 1 and 3 months compared with the contralateral limb and controls (VL only) but increased from 1 to 3 months. Changes in QMQ and CSA were not correlated. CONCLUSIONS QMQ declines within the first month after ACLR and does not improve by 3 months although hypertrophy occurs, suggesting that these morphological characteristics change independently after ACLR. Poorer QMQ represents greater concentration of noncontractile tissues within the muscle and potentially contributes to chronic quadriceps dysfunction observed after ACLR.
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Affiliation(s)
| | - Derek R Dewig
- Department of Health and Human Performance, Fairmont State University, Fairmont, WV
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Darin Padua
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eric D Ryan
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joe Hart
- Department of Orthopaedics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey Spang
- Department of Orthopaedics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Nilius A, Dewig DR, Johnston CD, Pietrosimone BG, Blackburn JT. Quadriceps composition and function influence downhill gait biomechanics >1 year following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 114:106229. [PMID: 38490072 DOI: 10.1016/j.clinbiomech.2024.106229] [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: 11/01/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Quadriceps dysfunction is common following anterior cruciate ligament reconstruction and contributes to aberrant gait biomechanics. Changes in quadriceps composition also occur in these patients including greater concentrations of non-contractile tissue. The purpose of this study was to evaluate associations between quadriceps composition, function, and gait biomechanics in individuals with anterior cruciate ligament reconstruction. METHODS Forty-eight volunteers with anterior cruciate ligament reconstruction completed gait biomechanics and quadriceps function and composition assessments. Gait biomechanics were sampled during downhill walking (-10° slope) on an instrumented treadmill. Quadriceps function (peak torque and rate of torque development) was assessed via maximal isometric contractions, while composition was evaluated via ultrasound echo intensity. FINDINGS Greater quadriceps peak torque was associated with a greater peak knee extension moment (r = 0.365, p = 0.015). Greater vastus lateralis echo intensity (i.e. poorer muscle quality) was associated with less knee flexion displacement (r = -0.316, p = 0.032). Greater echo intensity of the vastus lateralis (r = -0.298, p = 0.044) and rectus femoris (r = -0.322, p = 0.029) was associated with a more abducted knee angle at heel strike. Quadriceps peak torque explained 11-16% of the variance in echo intensity. INTERPRETATION Both quadriceps function and composition influence aberrant gait biomechanics following anterior cruciate ligament reconstruction. Quadriceps composition appears to provide insight into quadriceps dysfunction independent of muscle strength, as they associated with different gait biomechanics outcomes and shared minimal variance. Future research is necessary to determine the influence of changes in quadriceps composition on joint health outcomes.
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Affiliation(s)
- Alex Nilius
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA
| | - Derek R Dewig
- College of Education, Health & Human Performance, Fairmont State University, USA
| | | | - Brian G Pietrosimone
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA
| | - J Troy Blackburn
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA.
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Riehm CD, Bonnette S, Rush JL, Diekfuss JA, Koohestani M, Myer GD, Norte GE, Sherman DA. Corticomuscular cross-recurrence analysis reveals between-limb differences in motor control among individuals with ACL reconstruction. Exp Brain Res 2024; 242:355-365. [PMID: 38092900 PMCID: PMC10872341 DOI: 10.1007/s00221-023-06751-1] [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] [Received: 07/27/2023] [Accepted: 11/16/2023] [Indexed: 01/04/2024]
Abstract
Surgical reconstruction of the anterior cruciate ligament (ACL) and subsequent physical therapy can help athletes return to competition; however, re-injury rates remain disproportionately high due, in part, to lingering biomechanical and neurological factors that are not fully addressed during rehabilitation. Prior reports indicate that individuals exhibit altered electrical activity in both brain and muscle after ACL reconstruction (ACLR). In this investigation, we aimed to extend existing approaches by introducing a novel non-linear analysis of corticomuscular dynamics, which does not assume oscillatory coupling between brain and muscle: Corticomuscular cross-recurrence analysis (CM-cRQA). Our findings indicate that corticomuscular dynamics vary significantly between involved (injured) and uninvolved legs of participants with ACLR during voluntary isometric contractions between the brain and both the vastus medialis and lateralis. This finding points to a potential lingering neural deficit underlying re-injury for athletes after surgical reconstruction, namely the dynamical structure of neuromuscular (brain to quad muscle) coordination, which is significantly asymmetric, between limbs, in those who have ACLR.
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Affiliation(s)
- Christopher D Riehm
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA.
- Emory Sports Medicine Center, Atlanta, GA, USA.
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Justin L Rush
- Division of Physical Therapy, School of Rehabilitation Sciences, Ohio University, Athens, OH, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Moein Koohestani
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Grant E Norte
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - David A Sherman
- Live4 Physical Therapy and Wellness, Acton, MA, USA
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
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Grozier C, Keen M, Collins K, Tolzman J, Fajardo R, Slade JM, Kuenze C, Harkey MS. Rectus Femoris Ultrasound Echo Intensity Is a Valid Estimate of Percent Intramuscular Fat in Patients Following Anterior Cruciate Ligament Reconstruction. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2590-2595. [PMID: 37770296 PMCID: PMC10595047 DOI: 10.1016/j.ultrasmedbio.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE The aim of the work described here was to evaluate quadriceps muscle ultrasound metrics and common demographic variables to create a conversion equation that validly predicts magnetic resonance imaging (MRI) percent intramuscular fat after anterior cruciate ligament reconstruction (ACLR). METHODS We recruited 15 participants between the ages of 18 and 35 y who were 1-5 y post-ACLR. For the MRI assessment, we used an iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) sequence to assess the mid-thigh. A single reader manually segmented the rectus femoris on two consecutive MRI slices using ITK-Snap to estimate the percent intramuscular fat. For the ultrasound assessment, a single investigator captured transverse panoramic ultrasound images of the mid-thigh with the participant positioned supine and the knee flexed to 30°. A separate single reader used ImageJ to manually segment the rectus femoris ultrasound images. Ultrasound metrics included muscle cross-sectional area, echo intensity and subcutaneous fat thickness. A stepwise linear multiple regression was used to develop an equation to predict MRI percent intramuscular fat using the ultrasound metrics and common demographics (i.e., age, sex, height, mass). Additionally, intraclass correlation coefficients (ICC2,k) and Bland-Altman plots were used to assess the agreement between true and estimated percent intramuscular fat. RESULTS Echo intensity and age significantly predicted MRI intramuscular fat percent (p = 0.003, r2 = 0.62). When using the conversion equation, there was high agreement (ICC2,k = 0.87, 95% confidence interval: 0.62-0.96) between the estimated and true percent intramuscular fat. CONCLUSION Our patient population-specific conversion equation that uses quadriceps muscle ultrasound echo intensity and age is a valid estimate of MRI percent intramuscular fat.
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Affiliation(s)
- Corey Grozier
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Megan Keen
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Katherine Collins
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Jessica Tolzman
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | | | - Jill M Slade
- Department of Radiology, Michigan State University, East Lansing, MI, USA
| | - Christopher Kuenze
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Matthew S Harkey
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA.
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Ito N, Sigurðsson HB, Snyder-Mackler L, Grävare Silbernagel K. Time to treat the tendon rupture induced by surgery: early hypertrophy of the patellar tendon graft site predicts strong quadriceps after ACLR with bone-patellar tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc 2023; 31:5791-5798. [PMID: 37934286 PMCID: PMC10842920 DOI: 10.1007/s00167-023-07657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Quadriceps dysfunction is ubiquitous after anterior cruciate ligament reconstruction, especially when using bone-patellar tendon-bone (BPTB) autografts. The role of patellar tendon hypertrophy after graft harvest on knee extensor strength is unknown. The purpose of this study was to determine the predictive ability of patellar tendon (PT) and quadriceps muscle (Quad) cross-sectional area (CSA) on knee extensor strength 1-2 months after ACLR using BPTB autografts. METHODS This is a cross-sectional analysis of a cohort 1-2 months after ACLR using BPTB autograft. Peak knee extensor torque, and PT and Quad CSA measured using ultrasound imaging, were collected in 13 males and 14 females. Simple linear regressions compared quadriceps strength index (QI) against limb symmetry index (LSI) in PT and Quad CSA. Multiple linear regressions with sequential model comparisons predicting peak knee extensor torque were performed for each limb. The base model included demographics. Quad CSA was added in the first model, then PT CSA was added in the second model. RESULTS Both PT (p < 0.001, R2 = 0.693) and Quadriceps CSA (p = 0.013, R2 = 0.223) LSI had a positive linear relationship with QI. In the involved limb, addition of PT CSA significantly improved the model (R2 = 0.781, ΔR2 = 0.211, p for ΔR2 < 0.001). In the uninvolved limb, the addition of Quad CSA improved the model, but the addition of PT CSA did not. CONCLUSION PT LSI was more predictive of QI than Quad CSA LSI. Involved limb PT CSA mattered more in predicting peak knee extensor torque than did Quad CSA, but in the uninvolved limb, Quad CSA was the most important predictor of peak knee extensor torque. Graft site patellar tendon hypertrophy is key for strong quadriceps early after ACLR. Early targeted loading via exercise to promote healing of the graft site patellar tendon may bring patients a step closer to winning their battle against quadriceps dysfunction. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | | | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Karin Grävare Silbernagel
- Biomechanics and Movement Science Program, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA.
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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Harput G, Demirci S, Nyland J, Soylu AR, Tunay VB. Sports activity level after ACL reconstruction is predicted by vastus medialis or vastus medialis obliquus thickness, single leg triple hop distance or 6-m timed hop, and quality of life score. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3483-3493. [PMID: 37198499 DOI: 10.1007/s00590-023-03571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Recovery after anterior cruciate ligament reconstruction (ACLR) may take > 2 years, and younger athletes have higher re-injury risk. The purpose of this prospective longitudinal study was to determine how the early to mid-term Tegner Activity Level Scale (TALS) scores of athletically active males ≥ 2 years post-ACLR follow-up was predicted by bilateral isokinetic knee extensor and flexor torque, quadriceps femoris thickness, single leg hop test performance, and self-reported knee function (Knee Injury and Osteoarthritis Outcome Score (KOOS); International Knee Documentation Committee (IKDC) Subjective Assessment score). METHODS After ACLR with a hamstring tendon autograft and safely returning to sports at least twice weekly, 23 men (18.4 ± 3.5 years of age) were evaluated at final follow-up (mean = 4.5, range = 2-7 years). Exploratory forward stepwise multiple regression was used to determine the relationship between independent surgical and non-surgical lower limb variables peak concentric isokinetic knee extensor-flexor torque at 60°/sec and 180°/sec, quadriceps femoris muscle thickness, single leg hop test profile results, KOOS subscale scores, IKDC Subjective Assessment scores, and time post-ACLR on TALS scores at final follow-up. RESULTS Subject TALS scores were predicted by KOOS quality of life subscale score, surgical limb vastus medialis obliquus (VMO) thickness, and surgical limb single leg triple hop for distance (SLTHD) performance. Subject TALS scores were also predicted by KOOS quality of life subscale score, non-surgical limb vastus medialis (VM) thickness, and non-surgical limb 6 m single leg timed hop (6MSLTH) performance. CONCLUSION TALS scores were influenced differently by surgical and non-surgical lower extremity factors. At ≥ 2 years post-ACLR, ultrasound VM and VMO thickness measurements, single leg hop tests that challenge knee extensor function, and self-reported quality of life measurements predicted sports activity levels. The SLTHD test may be better than the 6MSLTH for predicting long-term surgical limb function.
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Affiliation(s)
- Gulcan Harput
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Serdar Demirci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Balıkesir University, Balıkesir, Turkey
| | - John Nyland
- Kosair Charities College of Health and Natural Sciences, Athletic Training Program, Norton Orthopedic Institute, Spalding University, 901 South 4Th Street, Louisville, KY, USA.
| | - Abdullah Ruhi Soylu
- Department of Biophysics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Volga Bayrakci Tunay
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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9
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Losciale JM, Truong LK, Zhang K, Scarr T, Xie H, Li LC, Mitchell C, Hunt MA, Whittaker JL. The association between knee muscle performance and clinical outcomes of knee function 1-4 years after a sport-related knee joint injury. Phys Ther Sport 2023; 64:147-155. [PMID: 37922747 DOI: 10.1016/j.ptsp.2023.10.003] [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: 08/07/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Estimate the association between index leg knee muscle strength and rate of torque development (RTD), and self-reported and performance-based (i.e., hop) knee function in persons 1-4 years after a sport-related knee joint injury. METHODS Data were collected at baseline of a clinical trial. Assessments included the Knee injury and Osteoarthritis Outcome Score Sport & Recreation subscale (KOOSsport), 6-m timed hop (TH), and peak concentric isokinetic knee extensor and flexor torque and isometric RTD. Associations between peak torque and RTD with KOOSsport and TH were assessed using multivariable regression with nonlinear transformations. RESULTS 53 participants (64.2% female) were included. Knee extensor peak torque was nonlinearly related to TH time, with a strong inverse relationship at lower torque values that changed as torque increased. Results were inconsistent for flexor peak torque, extensor RTD and flexor RTD, with inconsistencies in relationship shape and estimates of association between primary and sensitivity analyses. There was no association between strength/RTD and KOOSsport. CONCLUSION There was a nonlinear relationship between knee extensor strength and hop function, with lower strength being associated with a stronger relationship. As strength values increased, the relationship attenuated. Knee extensor and flexor strength, or RTD, were not associated with self-reported function.
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Affiliation(s)
- Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Kexin Zhang
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Thomas Scarr
- Allan McGavin Sports Medicine Clinic, Vancouver, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Cameron Mitchell
- Department of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada.
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10
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Harput G, Demirci S, Soylu AR, Bayrakci Tunay V. Association between quadriceps muscle thickness and knee function in anterior cruciate ligament reconstructed athletes: a cross-sectional study. Physiother Theory Pract 2023; 39:2171-2179. [PMID: 35442153 DOI: 10.1080/09593985.2022.2068096] [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: 09/29/2021] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between vastus medialis obliquus (VMO), rectus femoris (RF), and vastus lateralis (VL) muscle thickness and quadriceps isokinetic strength, single-leg hop performance, and self-reported knee function in male athletes who had undergone anterior cruciate ligament reconstruction (ACLR). METHODS Forty-two male athletes [mean ± standard deviation, age: 21.4 ± 3.4 years], who had undergone ACLR and had cleared to return to activity, were included in this study. Real-time ultrasound images of VMO, RF, and VL thicknesses were obtained from both reconstructed and contralateral limbs. Concentric quadriceps peak torque at 60°/s and 180°/s, single-leg hop for Distance (SLHD), and self-reported knee function scores were also assessed. Linear regression analysis and student t tests were used for statistical analysis. RESULTS In reconstructed limb, greater VMO, RF, and VL thicknesses were associated with greater quadriceps peak torque at 60°/s (p = .008, r2 = 0.46) and at 180°/s (p = .006, r2 = 0.47). Greater quadriceps thickness was related to greater SLHD score in reconstructed limb (p = .002, r2 = 0.21). Self-reported knee function scores were not related to quadriceps thickness. VMO, RF, and VL thicknesses were smaller in reconstructed limb compared to contralateral limb (p < .001, p = .01, and p = .002, respectively). CONCLUSION Quadriceps thickness by using ultrasound was associated with concentric quadriceps strength and single-leg hop distance in individuals who had undergone ACLR. However, quadriceps thickness was not related to self-reported knee function. The ultrasonography may be included in the evaluation of the knee function after ACLR, and it may be a useful and easy method in the follow-up of the quadriceps strength recovery following ACLR.
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Affiliation(s)
- Gulcan Harput
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Serdar Demirci
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Balıkesir University, Bigadic, Turkey
| | - Abdullah Ruhi Soylu
- Faculty of Medicine, Department of Biophysics, Hacettepe University, Ankara, Turkey
| | - Volga Bayrakci Tunay
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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11
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Tavares MLA, Lima PODP, Albano TR, Rodrigues CAS, Almeida GPL. The Relationship of Knee-related Quality of Life With Function, Psychological Factors, Strength, Performance, and Postural Stability After ACL Reconstruction: A Cross-Sectional Study. Sports Health 2023; 15:192-198. [PMID: 36154529 PMCID: PMC9950995 DOI: 10.1177/19417381221123517] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients after anterior cruciate ligament reconstruction (ACLR) have decreased health-related quality of life (QoL) compared with healthy control participants. Few studies have verified the predictors of QoL using Quality of Life Outcome Measure Questionnaire for Chronic Anterior Cruciate Ligament Deficiency (ACL-QoL), and no study has verified the relationship of psychological factors and knee function with ACL-QoL in patients after ACLR. HYPOTHESIS Knee functional status, muscle strength, performance in hop tests, postural stability, and psychological factors would be the predictors of QoL after ACLR. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 4. METHODS A total of 131 participants who had undergone ACLR at least 6 months previously were evaluated. QoL was assessed using ACL-QoL; knee functional status, using International Knee Documentation Committee Subjective Knee (IKDC) and global rating scale (GRS); psychological readiness, using Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI); kinesiophobia, using Tampa Scale for Kinesiophobia (TSK-17); knee strength, using isokinetic dynamometer; performance, using single-leg hop tests; and postural stability, using Biodex Balance System. Pearson's linear correlation and stepwise hierarchical multiple linear regression analyses were performed to verify the predictors of QoL. RESULTS ACL-QoL showed a moderate correlation with IKDC (r = 0.69), GRS (r = 0.55), ACL-RSI (r = 0.50), and TSK-17 (r = -0.49). ACL-QoL presented none to low correlations with the variables of muscle strength, postural stability, and performance in hop tests. The variables related to the knee functional status and psychological factors (IKDC, GRS, ACL-RSI, and TSK-17) were found to be the predictors of QoL (R2 = 0.56; P = 0.01). CONCLUSION Knee functional status, psychological readiness, and kinesiophobia were the predictors of knee-related QoL in patients after ACLR. CLINICAL RELEVANCE These results can assist clinicians in the therapeutic monitoring of the factors that may interfere with QoL in patients after ACLR.
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Affiliation(s)
- Maria Larissa Azevedo Tavares
- Knee and Sports Research Group,
Physical Therapy Department, School of Medicine, Federal University of Ceará,
Fortaleza, CE, Brazil
- Master Program in Physical Therapy and
Functioning, Physical Therapy Department, School of Medicine, Federal University of
Ceará, Fortaleza, CE, Brazil
| | - Pedro Olavo de Paula Lima
- Knee and Sports Research Group,
Physical Therapy Department, School of Medicine, Federal University of Ceará,
Fortaleza, CE, Brazil
- Master Program in Physical Therapy and
Functioning, Physical Therapy Department, School of Medicine, Federal University of
Ceará, Fortaleza, CE, Brazil
| | - Thamyla Rocha Albano
- Knee and Sports Research Group,
Physical Therapy Department, School of Medicine, Federal University of Ceará,
Fortaleza, CE, Brazil
- Master Program in Physical Therapy and
Functioning, Physical Therapy Department, School of Medicine, Federal University of
Ceará, Fortaleza, CE, Brazil
| | - Carlos Augusto Silva Rodrigues
- Knee and Sports Research Group,
Physical Therapy Department, School of Medicine, Federal University of Ceará,
Fortaleza, CE, Brazil
- Master Program in Physical Therapy and
Functioning, Physical Therapy Department, School of Medicine, Federal University of
Ceará, Fortaleza, CE, Brazil
| | - Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group,
Physical Therapy Department, School of Medicine, Federal University of Ceará,
Fortaleza, CE, Brazil
- Master Program in Physical Therapy and
Functioning, Physical Therapy Department, School of Medicine, Federal University of
Ceará, Fortaleza, CE, Brazil
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12
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Cleary CJ, Herda TJ, Quick AM, Herda AA. Acute muscle swelling effects of a knee rehabilitation exercise performed with and without blood flow restriction. PLoS One 2022; 17:e0278540. [PMID: 36548274 PMCID: PMC9778495 DOI: 10.1371/journal.pone.0278540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
This study assessed the acute effect of adding blood flow restriction (BFR) to quad sets on muscle-cross sectional area (mCSA), muscle thickness (MT), echo intensity (EI), and subcutaneous fat-normalized EI (EINORM) of the superficial quadriceps muscles. Twelve males and 12 females (mean±SD; age (yrs): 21.4±2.9; stature (m): 1.76±0.1; body mass (kg): 77.7±2.9) performed 70 repetitions (one set of 30, three sets of 15 repetitions) of bodyweight quad sets separately on each leg, with or without BFR (CON) applied. Rating of perceived exertion was recorded following each set. Panoramic ultrasound images of the vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF) were captured prior to (PRE), immediately after (IMM-POST), 30- (30-POST), and 60-minutes after (60-POST) after exercise. Sex x condition x time repeated measures ANOVAs assessed differences at p<0.05 for each muscle and dependent variable separately. Although males had larger VM and VL mCSA and VL MT (p<0.05), there were no acute changes from PRE to IMM-POST (p>0.05). There was a 3-way interaction in VL mCSA (p = 0.025) which indicated BFR was greater than CON at IMM-POST by 7.6% (p = 0.019) for males only. Females had greater EI in the VM and VL than males (p<0.05), yet males had greater EINORM for each muscle (p>0.05) and EINORM did not change over time or treatment (p>0.05). The lack of changes in MT, EI, and EINORM indicate that unloaded quad sets do not provide a stimulus to promote fluid shifts or acute changes in muscle size with the exception of IMM-POST in the VL for males. Future research should attempt to elucidate the acute muscular responses of BFR application for lightly loaded rehabilitation exercises in the clinical populations for which they are prescribed.
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Affiliation(s)
- Christopher J. Cleary
- Department of Health, Sport, and Exercise Sciences, University of Kansas Edwards Campus, Overland Park, Kansas, United States of America
| | - Trent J. Herda
- Department of Health, Sport, and Exercise Sciences, University of Kansas Lawrence Campus, Lawrence, Kansas, United States of America
| | - Austin M. Quick
- Department of Health, Sport, and Exercise Sciences, University of Kansas Lawrence Campus, Lawrence, 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
- * E-mail:
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13
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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: 20] [Impact Index Per Article: 10.0] [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.
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14
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Garcia SA, Brown SR, Koje M, Krishnan C, Palmieri-Smith RM. Gait asymmetries are exacerbated at faster walking speeds in individuals with acute anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:219-230. [PMID: 34101887 PMCID: PMC8651805 DOI: 10.1002/jor.25117] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/10/2021] [Accepted: 05/10/2021] [Indexed: 02/04/2023]
Abstract
Previous research suggests more biomechanically demanding tasks (e.g., stair descent, hopping) magnify biomechanical asymmetries compared with walking after anterior cruciate ligament (ACL) reconstruction. However, it is unclear if modifying task-specific constraints, like walking speed also elicits greater biomechanical asymmetries in this population. We examined the effects of manipulating walking speed on ground reaction force (GRF) asymmetries in individuals with ACL reconstruction and uninjured controls. Thirty individuals with ACL reconstruction (age = 20.6 ± 5.4 years, body mass index [BMI] = 23.9 ± 3.3 kg/m2 ) and 15 controls (age = 23.1 ± 4.5 years, BMI = 23.6 ± 2.7 kg/m2 ) were tested on an instrumented treadmill at three speeds (100%, 120%, and 80% self-selected speed). Bilateral vertical and posterior-anterior GRFs were recorded at each speed. GRF asymmetries were calculated by subtracting the uninjured from the injured limb at each percent of stance. Statistical parametric mapping was used to evaluate the effects of speed on GRF asymmetries across stance. We found vertical and posterior GRF asymmetries were exacerbated at faster speeds and reduced at slower speeds in ACL individuals but not controls (p < .05). No differences in anterior GRF asymmetries were observed between speeds in either group (p > .05). Our results suggest increasing walking speed magnifies GRF asymmetries in individuals with ACL reconstruction. Statement of Clinical Significance: Evaluating both preferred and fast walking speeds may aid in characterizing biomechanical asymmetries in individuals with ACL reconstruction which may be valuable in earlier rehabilitative time points when more difficult tasks like hopping and running are not feasible.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott R Brown
- Department of Kinesiology, Aquinas College, Grand Rapids, Michigan, USA
| | - Mary Koje
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Neuromuscular & Rehabilitation Robotics (NeuRRo) Laboratory, Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Neuromuscular & Rehabilitation Robotics (NeuRRo) Laboratory, Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- Robotics Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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15
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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.
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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
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16
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Cabre HE, Greenwalt CE, Gould LM, Hirsch KR, Blue MNM, Smith-Ryan AE. Exploring the "Athlete's Paradox": Division I Cross-Country Runners Demonstrate Similar Muscle Characteristics to Recreationally Trained Young Adults. J Strength Cond Res 2021; 35:3213-3217. [PMID: 34474434 DOI: 10.1519/jsc.0000000000004127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Cabre, HE, Greenwalt, CE, Gould, LM, Hirsch, KR, Blue, MNM, and Smith-Ryan, AE. Exploring the "Athlete's Paradox": Division I cross-country runners demonstrate similar muscle characteristics to recreationally trained young adults. J Strength Cond Res XX(X): 000-000, 2021-Endurance training can influence body composition and muscle characteristics. Endurance athletes have demonstrated elevated intramuscular fat (IMF), yet individuals with greater body fat also demonstrate elevated IMF. The purpose of this study was to examine differences in muscle characteristics (echo intensity [EI] and muscle cross-sectional area [mCSA]) and body composition between Division I collegiate athletes and college-age adults matched for percent fat (%fat). Thirty cross-country athletes (XC) and 30 normal-weight (NW) recreationally active college students (male athletes: n = 30; female athletes: n = 30; mean ± SD: age: 19.2 ± 1.1 years; body mass: 61.7 ± 8.7 kg; %fat: 18.0 ± 5.2%) underwent a panoramic ultrasound scan of the vastus lateralis to evaluate EI and mCSA. A full-body dual-energy x-ray absorptiometry scan was used to assess fat mass (FM), lean mass (LM), and %fat. Independent t-tests were used to evaluate mCSA, EI, and body composition. Significance level was set at ≤ 0.05. There were no significant differences between the XC and NW cohorts in mCSA (mean difference [MD; XC - NW], -1.30 ± -0.40 cm3; p = 0.340) or EI (MD: 3.97 ± 2.66 a.u.; p = 0.478). Body composition was not different between the groups: FM (MD: -0.14 ± -0.54 kg; p = 0.848), LM (-3.07 ± 1.25 kg; p = 0.268), or bone mineral content (-0.21 ± 0.03 kg; p = 0.120). There were also no significant differences for any outcome variables when stratified by male athletes (p = 0.097-0.468) or female athletes (p = 0.055-0.700). These results suggest that XC athletes may have similar muscle characteristics to NW individuals when matched for %fat. Understanding and tracking muscle characteristics in XC athletes may be important for performance, injury prevention, and the transition to retirement.
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Affiliation(s)
- Hannah E Cabre
- Applied Physiology Laboratory, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina; Human Movement Science Curriculum, Department of Allied Health Science, University of North Carolina, Chapel Hill, North Carolina; Institute of Sport Science Medicine, Department of Nutrition, Food, and Exercise Science, Florida State University, Tallahassee, Florida; Center for Translational Research in Aging and Longevity, Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Human Biomechanics and Applied Physiology Lab, Department of Exercise Science, High Point University, One University Parkway, High Point, North Carolina
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Strength, rate of force development, power and reactive strength in adult male athletic populations post anterior cruciate ligament reconstruction - A systematic review and meta-analysis. Phys Ther Sport 2021; 47:91-104. [DOI: 10.1016/j.ptsp.2020.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/26/2022]
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18
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Garcia SA, Curran MT, Palmieri-Smith RM. Longitudinal Assessment of Quadriceps Muscle Morphology Before and After Anterior Cruciate Ligament Reconstruction and Its Associations With Patient-Reported Outcomes. Sports Health 2020; 12:271-278. [PMID: 32091298 DOI: 10.1177/1941738119898210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Reductions in muscle size are common after anterior cruciate ligament reconstruction (ACLR) and may contribute to suboptimal patient outcomes. However, few studies have quantified postoperative alterations in muscle quality and evaluated its associations with patient-reported function. HYPOTHESES Rectus femoris cross-sectional area (CSA) will decrease postoperatively but improve at return to activity (RTA), rectus femoris muscle quality (percentage fat [PF]) will increase postoperatively and be greater at RTA compared with preoperative values, and rectus femoris CSA and PF will be associated with International Knee Documentation Committee (IKDC) scores at both postoperative time points. STUDY DESIGN Case series. LEVEL OF EVIDENCE Level 4. METHODS A total of 26 individuals who sustained an ACL injury and underwent reconstructive surgery were evaluated preoperatively (T0), 9 weeks post-ACLR (T1), and at RTA. Rectus femoris CSA and PF were evaluated bilaterally via ultrasound imaging, and patient-reported function was assessed using the IKDC score. RESULTS Bilateral reductions in rectus femoris CSA were noted from T0 to T1 (P < 0.01). Only the uninvolved limb returned to preoperative CSA (P = 0.80), as the involved limb failed to return to preoperative levels at RTA (P = 0.04). No significant changes in rectus femoris PF were observed across time points (P > 0.05). Lesser PF (P < 0.01) but not CSA (P = 0.75) was associated with higher IKDC score at T1. Lesser PF (P = 0.04) and greater CSA (P = 0.05) was associated with higher IKDC score at RTA. CONCLUSION Substantial atrophy occurs bilaterally after ACLR, and the involved limb does not return to preoperative muscle size despite the patient completing rehabilitation. Quadriceps muscle morphology is associated with patient-reported function and may be an important rehabilitation target after ACLR. CLINICAL RELEVANCE Quadriceps atrophy and poor muscle quality may contribute to suboptimal patient functioning and quadriceps dysfunction and may be important in RTA decision making. Assessing muscle morphology using ultrasound may be a feasible and clinically beneficial tool in patients after ACLR.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Michael T Curran
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, Michigan
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