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Finco MG, Finnerty C, Ngo W, Menegaz RA. Indications of musculoskeletal health in deceased male individuals with lower-limb amputations: comparison to non-amputee and diabetic controls. Sci Rep 2023; 13:8838. [PMID: 37258530 DOI: 10.1038/s41598-023-34773-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/08/2023] [Indexed: 06/02/2023] Open
Abstract
Individuals with lower-limb amputations, many of whom have type 2 diabetes, experience impaired musculoskeletal health. This study: (1) compared residual and intact limbs of diabetic and non-diabetic post-mortem individuals with amputation to identify structures vulnerable to injury, and (2) compared findings to diabetic and healthy control groups to differentiate influences of amputation and diabetes on musculoskeletal health. Postmortem CT scans of three groups, ten individuals each, were included: (1) individuals with transtibial or transfemoral amputations, half with diabetes (2) diabetic controls, and (3) healthy controls. Hip and knee joint spaces, cross-sectional thigh muscle and fat areas, and cross-sectional bone properties (e.g. area, thickness, geometry) were measured. Wilcoxon Signed-Rank and Kruskal-Wallis tests assessed statistical significance. Asymmetry percentages between limbs assessed clinical significance. Residual limbs of individuals with amputation, particularly those with diabetes, had significantly less thigh muscle area and thinner distal femoral cortical bone compared to intact limbs. Compared to control groups, individuals with amputation had significantly narrower joint spaces, less thigh muscle area bilaterally, and thinner proximal femoral cortical bone in the residual limb. Diabetic individuals with amputation had the most clinically significant asymmetry. Findings tended to align with those of living individuals. However, lack of available medical information and small sample sizes reduced the anticipated clinical utility. Larger sample sizes of living individuals are needed to assess generalizability of findings. Quantifying musculoskeletal properties and differentiating influences of amputation and diabetes could eventually help direct rehabilitation techniques.
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Affiliation(s)
- M G Finco
- Department of Physiology and Anatomy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, USA.
| | - Caitlyn Finnerty
- Department of Health and Exercise Science, The College of New Jersey, 2000 Pennington Rd, Ewing, NJ, USA
| | - Wayne Ngo
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, USA
| | - Rachel A Menegaz
- Department of Physiology and Anatomy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, USA
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Henson DP, Edgar C, Ding Z, Sivapuratharasu B, Le Feuvre P, Finnegan ME, Quest R, McGregor AH, Bull AMJ. Understanding lower limb muscle volume adaptations to amputation. J Biomech 2021; 125:110599. [PMID: 34265657 DOI: 10.1016/j.jbiomech.2021.110599] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022]
Abstract
Amputation of a major limb, and the subsequent return to movement with a prosthesis, requires the development of compensatory strategies to account for the loss. Such strategies, over time, lead to regional muscle atrophy and hypertrophy through chronic under or overuse of muscles compared to uninjured individuals. The aim of this study was to quantify the lower limb muscle parameters of persons with transtibial and transfemoral amputations using high resolution MRI to ascertain muscle volume and to determine regression equations for predicting muscle volume using femur- and tibia-length, pelvic-width, height, and mass. Twelve persons with limb loss participated in this study and their data were compared to six matched control subjects. Subjects with unilateral transtibial amputation showed whole-limb muscle volume loss in the residual-limb, whereas minor volume changes in the intact limb were found, providing evidence for a compensation strategy that is dominated by the intact-limb. Subjects with bilateral-transfemoral amputations showed significant muscle volume increases in the short adductor muscles with an insertion not affected by the amputation, the hip flexors, and the gluteus medius, and significant volume decreases in the longer adductor muscles, rectus femoris, and hamstrings. This study presents a benchmark measure of muscle volume discrepancies in persons with limb-loss, and can be used to understand the compensation strategies of persons with limb-loss and the impact on muscle volume, thus enabling the development of optimised intervention protocols, conditioning therapies, surgical techniques, and prosthetic devices that promote and enhance functional capability within the population of persons with limb loss.
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Affiliation(s)
- David P Henson
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK.
| | - Caitlin Edgar
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK
| | - Ziyun Ding
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK; The Department of Mechanical Engineering, University of Birmingham, UK
| | - Biranavan Sivapuratharasu
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK; The Department of Surgery and Cancer, Imperial College London, UK
| | - Peter Le Feuvre
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Surgery and Cancer, Imperial College London, UK
| | - Mary E Finnegan
- The Department of Bioengineering, Imperial College London, UK; The Department of Imaging, Imperial College Healthcare NHS Trust, Imperial College London, UK
| | - Rebecca Quest
- The Department of Bioengineering, Imperial College London, UK; The Department of Imaging, Imperial College Healthcare NHS Trust, Imperial College London, UK
| | - Alison H McGregor
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Surgery and Cancer, Imperial College London, UK
| | - Anthony M J Bull
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, UK; The Department of Bioengineering, Imperial College London, UK
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