Relationship between muscle echo intensity on ultrasound and isokinetic strength of the three superficial quadriceps femoris muscles in healthy young adults

Ultrasound guided compressibility of the lower leg anterior tibial muscle compartment: a feasibility study

OBJECTIVES

Some young individuals participating in sports activities may encounter lower leg muscle pain and tightness, potentially indicating chronic exertional compartment syndrome (CECS). While muscle pressure measurement is typically recommended for diagnosis, it is invasive and associated with low sensitivity and specificity. Thus, there is a need for novel diagnostic approaches.

METHODS

This feasibility study aims to assess whether an ultrasound-guided technique can effectively measure the compressibility of the anterior tibial muscle compartment, focusing on optimal leg positioning and identifying reliable external and internal anatomical landmarks. The compressibility of the anterior tibial muscle compartment was evaluated using ultrasound images obtained at 10 mmHg and 80 mmHg external pressure, with the drop in compartment thickness used to calculate the compressibility ratio. Measurements were conducted in various leg positions and utilizing different external and internal landmarks.

RESULTS

Studies in healthy volunteers showed that knee and heel support positioning, measuring at the leg's widest circumference, and using the interosseous membrane as an internal landmark yielded the lowest measurement variability with an intra class correlation of .977 (.764-1.000; 95%-confidence interval).

CONCLUSION

These findings suggest that ultrasound-guided techniques can feasibly determine the compressibility ratio of the anterior tibial muscle compartment, providing valuable insights for standardized protocols in future studies on suspected cases of chronic exertional compartment syndrome.

Automatic Quantitative Assessment of Muscle Strength Based on Deep Learning and Ultrasound

Skeletal muscle is a vital organ that promotes human movement and maintains posture. Accurate assessment of muscle strength is helpful to provide valuable insights for athletes' rehabilitation and strength training. However, traditional techniques rely heavily on the operator's expertise, which may affect the accuracy of the results. In this study, we propose an automated method to evaluate muscle strength using ultrasound and deep learning techniques. B-mode ultrasound data of biceps brachii of multiple athletes at different strength levels were collected and then used to train our deep learning model. To evaluate the effectiveness of this method, this study tested the contraction of the biceps brachii under different force levels. The classification accuracy of this method for grade 4 and grade 6 muscle strength reached 98% and 96%, respectively, and the overall average accuracy was 93% and 87%, respectively. The experimental results confirm that the innovative methods in this paper can accurately and effectively evaluate and classify muscle strength.

Exploring the Relationship between Ultrasonographic Measures of the Quadriceps and Knee Extensor Muscle Fitness in Endurance-Trained Individuals

Background

B-mode ultrasonography is an accessible and cost-effective method to assess muscle size and quality through muscle thickness (MT) and echo intensity (EI), respectively. Muscle thickness and EI have demonstrated relationships with maximal strength and local muscle endurance, providing a noninvasive and efficient modality to examine muscle fitness. However, these relationships have not been quantified in the individual quadriceps muscles of habitually endurance-trained populations, which may provide information to practitioners regarding rehabilitation and performance.

Methods

Twenty-three participants (males: N = 10; females: N = 13) underwent B-mode ultrasonography to assess MT, EI, and adipose tissue thickness-corrected echo intensity (cEI) in the vastus intermedius (VI), vastus lateralis (VL), and rectus femoris (RF). Muscle fitness was evaluated through maximal strength (1RM) and local muscle endurance (4 sets to failure at 50% 1RM) during dynamic knee extension. Relationships between ultrasonography outcomes and muscle fitness were examined through stepwise multiple linear regression.

Results

The results indicate that VI cEI is the strongest predictor of 1RM strength (r = -0.643), while no ultrasonography-derived measures significantly predicted local muscle endurance.

Conclusion

The study demonstrates that ultrasonography, specifically measures of cEI in the VI, has the greatest association with maximal strength in endurance-trained individuals. These findings suggest monitoring VI muscle size and quality may benefit practitioners who aim to improve knee extension strength for performance or following injury. In addition, the findings support the use of EI examinations in trained populations.

Quadriceps composition and function influence downhill gait biomechanics >1 year following anterior cruciate ligament reconstruction

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.

Factors of Muscle Quality and Determinants of Muscle Strength: A Systematic Literature Review

Muscle quality defined as the ratio of muscle strength to muscle mass disregards underlying factors which influence muscle strength. The aim of this review was to investigate the relationship of phase angle (PhA), echo intensity (EI), muscular adipose tissue (MAT), muscle fiber type, fascicle pennation angle (θf), fascicle length (lf), muscle oxidative capacity, insulin sensitivity (IS), neuromuscular activation, and motor unit to muscle strength. PubMed search was performed in 2021. The inclusion criteria were: (i) original research, (ii) human participants, (iii) adults (≥18 years). Exclusion criteria were: (i) no full-text, (ii) non-English or -German language, (iii) pathologies. Forty-one studies were identified. Nine studies found a weak−moderate negative (range r: [−0.26]−[−0.656], p < 0.05) correlation between muscle strength and EI. Four studies found a weak−moderate positive correlation (range r: 0.177−0.696, p < 0.05) between muscle strength and PhA. Two studies found a moderate-strong negative correlation (range r: [−0.446]−[−0.87], p < 0.05) between muscle strength and MAT. Two studies found a weak-strong positive correlation (range r: 0.28−0.907, p < 0.05) between θf and muscle strength. Muscle oxidative capacity was found to be a predictor of muscle strength. This review highlights that the current definition of muscle quality should be expanded upon as to encompass all possible factors of muscle quality.

Ultrasound Measurements of Rectus Femoris and Locomotor Outcomes in Patients with Spinal Cord Injury

Patients with incomplete spinal cord injury have decreased mobility, and many do not recover walking ability. The purpose of this study was to investigate rectus femoris muscle thickness and echo intensity on ultrasound and functional outcomes in these patients. This was a prospective cohort study in an inpatient rehabilitation center, which recruited 40 consecutive patients with incomplete spinal cord injury. The patients underwent an ultrasound assessment at 6 weeks post-injury. Ultrasound measurements were performed using B-mode ultrasound scanning and standardized protocols. Functional outcomes on discharge, including Lower Extremity Muscle Score (LEMS), Functional Independence Measure (FIM), and Walking Index for Spinal Cord Injury II (WISCI II), were measured. Rectus femoris muscle thickness was significantly correlated with discharge LEMS (Spearman’s rho = 0.448; p = 0.004), FIM motor subscale (Spearman’s rho = 0.595; p < 0.001), FIM walk subscale (Spearman’s rho = 0.621; p < 0.001) and WISCI II (Spearman’s rho = 0.531; p < 0.001). The rectus femoris echo intensity was also significantly correlated with discharge LEMS (Spearman’s rho = −0.345; p = 0.029), FIM motor subscale (Spearman’s rho = −0.413; p = 0.008), FIM walk subscale (Spearman’s rho = −0.352; p = 0.026), and WISCI II (Spearman’s rho = −0.355; p = 0.025). We report that a relationship exists between rectus femoris muscle ultrasonographic characteristics and muscle function and ambulatory outcomes after inpatient rehabilitation. Ultrasound muscle measurements are potentially useful in assessing muscle wasting and function in patients with spinal cord injury.