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Ito N, Martin JA, Joachim MR, Blemker SS, Opar DA, Kliethermes SA, Heiderscheit BC, Baer G, Fabian K, Hammer E, Heidt D, Kuehl M, Lee K, Moll M, Peot R, Sanfilippo J, Tanaka C, Sund S, Lin YC, Hickey J, Homer A, Maniar N, Timmins R, Cousins M, DuCharme O, Feng X, Nguyen A, Riem L, Hart J, McCoy N, Allred D, Beutler A, Campbell D, Wayne Johnson A, Wilwand M, Mortensen B, Remington E, Hauenstein J, Metoyer C, Wagle J, Huff J, Port N, Reyes J. Quantifying Muscle Volume Deficits Among 38 Lower Extremity Muscles in Collegiate Football Athletes After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2025; 53:809-816. [PMID: 39876616 DOI: 10.1177/03635465241313235] [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] [Indexed: 01/30/2025]
Abstract
BACKGROUND Quadriceps dysfunction is ubiquitous after anterior cruciate ligament (ACL) reconstruction (ACLR). Addressing quadriceps dysfunction is crucial to improve function, reduce the reinjury risk, and maintain long-term knee health. While deficits specific to the quadriceps are well documented, less is known about the effect of an ACL injury on other lower extremity muscle groups. PURPOSE/HYPOTHESIS The purpose of this exploratory analysis was to quantify and rank lower extremity muscle volume deficits using magnetic resonance imaging in collegiate football athletes after ACLR. It was hypothesized that the quadriceps muscles would present with the greatest deficits and that compensatory hypertrophy of muscles at adjacent joints such as the hip and ankle would be observed. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This study is a secondary analysis from an ongoing multicenter prospective cohort study involving Division I collegiate football athletes. Athletes who underwent primary unilateral ACLR (1 [3%] allograft, 2 [7%] quadriceps tendon autograft, 22 [73%] bone-patellar tendon-bone autograft, 5 [17%] hamstring tendon autograft) and magnetic resonance imaging were included. Muscle volumes (mL·kg-1·m-1) were quantified bilaterally from 38 lower extremity muscles using machine learning technology. Paired-samples t tests were performed between limbs for each muscle, which were then ranked and visualized in a forest plot based on standardized mean differences (surgical - nonsurgical limb). RESULTS A total of 30 athletes (mean time from surgery, 27.9 ± 19.0 months) were included. The largest muscle volume deficits in the surgical limb were seen in the 3 uniarticular quadriceps muscles, followed by the biarticular triceps surae muscles. The rectus femoris and soleus did not show significant differences between limbs. Conversely, the fibularis muscle group had a greater muscle volume in the surgical limb compared with the nonsurgical limb. Most other muscle groups did not present significant differences between limbs. CONCLUSION Persistent quadriceps atrophy in a cohort of high-level athletes over 2 years after ACLR was highlighted in this study. Deficits in the gastrocnemius muscles, but not in the soleus, were also identified. This comprehensive approach examining various lower extremity muscles revealed latent muscle volume deficits present after ACLR.
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Affiliation(s)
- Naoaki Ito
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jack A Martin
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mikel R Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Silvia S Blemker
- Springbok Analytics, Charlottesville, Virginia, USA
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - David A Opar
- Sports Performance, Recovery, Injury and New Technologies Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Geoffrey Baer
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kurrel Fabian
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erin Hammer
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Danielle Heidt
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Matthew Kuehl
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kenneth Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael Moll
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ryan Peot
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jennifer Sanfilippo
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Claire Tanaka
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sarah Sund
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yi-Chung Lin
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, Australia
- School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, Australia
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jack Hickey
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, Australia
- School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, Australia
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ashleigh Homer
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, Australia
- School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, Australia
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nirav Maniar
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, Australia
- School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, Australia
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ryan Timmins
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, Australia
- School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, Australia
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Matthew Cousins
- Springbok Analytics, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Olivia DuCharme
- Springbok Analytics, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Xue Feng
- Springbok Analytics, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Anthony Nguyen
- Springbok Analytics, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lara Riem
- Springbok Analytics, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joseph Hart
- University of North Carolina, Chapel Hill, NC, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Noah McCoy
- University of North Carolina, Chapel Hill, NC, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Dain Allred
- Brigham Young University, Provo, UT, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Anthony Beutler
- Brigham Young University, Provo, UT, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Darren Campbell
- Brigham Young University, Provo, UT, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - A Wayne Johnson
- Brigham Young University, Provo, UT, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Malorie Wilwand
- Brigham Young University, Provo, UT, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Brett Mortensen
- Brigham Young University, Provo, UT, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Emma Remington
- Brigham Young University, Provo, UT, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jonathon Hauenstein
- University of Notre Dame, South Bend, IN, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Casey Metoyer
- University of Notre Dame, South Bend, IN, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - John Wagle
- University of Notre Dame, South Bend, IN, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Josh Huff
- Indiana University, Bloomington, IN, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicholas Port
- Indiana University, Bloomington, IN, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jordan Reyes
- Indiana University, Bloomington, IN, USA
- Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA
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Ito N, Capin JJ, Arhos EK, Wellsandt E, Pohlig RT, Buchanan TS, Snyder-Mackler L. Prolonged quadriceps latency during gait early after anterior cruciate ligament injury predicts radiographic knee osteoarthritis 6-years after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 117:106301. [PMID: 38945068 PMCID: PMC11250627 DOI: 10.1016/j.clinbiomech.2024.106301] [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: 03/04/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND The purpose was to explore quadriceps electromechanical function (quadriceps latency) during gait after anterior cruciate ligament injury as a predictor for radiographic knee osteoarthritis 6-years after anterior cruciate ligament reconstruction. Change in latency after preoperative physical therapy was also examined. METHODS Quadriceps latency (time between peak knee moment and quadriceps electromyography) was calculated before preoperative physical therapy (2.4 [0.5-7.5] months after anterior cruciate ligament injury) and after preoperative physical therapy in 24 athletes. Participants were dichotomized into osteoarthritis (Kellgren and Lawrence grade ≥ 2) and non-osteoarthritis groups at 6-years. Forward selection logistic regression was performed using z-score normalized quadriceps latency and demographics. A 2 × 2 repeated measure ANOVA was performed for quadriceps latency between groups before and after preoperative physical therapy. FINDINGS Quadriceps latency before preoperative physical therapy was the only predictor of 6-year radiographic osteoarthritis (p = 0.014, odds ratio [95% confidence interval] = 5.859 [1.435-23.924]). Time by group interaction was observed for quadriceps latency (p = 0.039, η2p = 0.179). In the osteoarthritis group, latency may reduce after training (before preoperative physical therapy = 115.7 ± 20.6 ms, after preoperative physical therapy = 99.5 ± 24.0 ms, p = 0.082). INTERPRETATION Prolonged latency after anterior cruciate ligament injury may predict post-traumatic knee osteoarthritis 6-years after anterior cruciate ligament reconstruction. Latency may shorten with preoperative physical therapy, yet athletes still moved on to develop osteoarthritis. Quadriceps function may need intervention immediately following anterior cruciate ligament injury for prevention of post-traumatic knee osteoarthritis.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, Madison, WI, USA; Badger Athletic Performance Program, University of Wisconsin - Madison, Madison, WI, USA.
| | - Jacob J Capin
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA; Medical College of Wisconsin, Clinical and Translational Science Institute, Milwaukee, WI, USA
| | - Elanna K Arhos
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Elizabeth Wellsandt
- Physical Therapy Program, Department of Health and Rehabilitation Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ryan T Pohlig
- Biostatistic Core Facility, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Thomas S Buchanan
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA; Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA
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