Bilateral Comparisons of Quadriceps Thickness after Anterior Cruciate Ligament Reconstruction

Time course of Quadriceps thickness changes over six months post-anterior cruciate ligament reconstruction: Unveiling critical impairments in vastii muscles

Vastii muscle adaptation caused by Quadriceps weakness observed after an Anterior Cruciate Ligament reconstruction (ACLr) remain debatable. We described the time course of changes in Quadriceps thickness, strength, and thigh circumference over six months following an ACLr. Quadriceps thicknesses, Quadriceps strength, and thigh circumference were measured preoperative, 3, and 6 months post-ACLr surgery in 103 patients (77 men and 26 women). Limbs and time were compared with repeated-measures ANOVA and the Intra-class correlation coefficient was determined (α = 5 %). From 0 to 3 months post-surgery, Quadriceps strength (p < 0.05), and VI (p < 0.05) and VL (p < 0.001) thicknesses were reduced. From 3 to 6 months, Quadriceps strength (p < 0.05), total Quadriceps thickness (p < 0.001), and VI (p < 0.001) and VL (p < 0.05) thicknesses increased. VM and RF thicknesses increase to 3 months after ACLr (p < 0.05). Quadriceps strength, circumference at 5 cm, VI, VL, VM, and total Quadriceps thickness remain lower than the contralateral limb 6 months following an ACLr (p < 0.05). Quadriceps thickness adapts heterogeneously, with VI and VL atrophying for up to three months, developing the highest Quadriceps weakness. By 6 months, VI does not recover its thickness proportion, and VI and VL do not return to pre-surgery conditions. Both vastii muscles align with Quadriceps strength changes over six months posterior ACLr.

Isokinetic quadriceps physiotherapy after knee surgery: a retrospective study

Introduction

Quadriceps weakness after knee surgery is the most common consequence that can have different consequences not only for the knee itself but also for the locomotor system in general. This study aimed to compare the results of isokinetic and isotonic exercise on torque restoration quadriceps on knee surgery.

Methods

A sample of 180 subjects was analyzed and divided into two subsamples according to the type of rehabilitation protocol that was implemented. The examined group A-isokinetic consisted of 90 male subjects aged 28.54 ± 4.44 years, with a rehabilitation protocol based on the isokinetic exercise of the quadriceps. The examined group B-isotonic also consisted of 90 male subjects aged 27.93 ± 4.27 years, with a rehabilitation protocol for strengthening the quadriceps that applied an exercise program with additional resistance, i.e., isotonic exercise in the gym. Before the start of the rehabilitation treatment, an initial isokinetic test was performed at an angular speed of 60 °/s in all subjects. After 3 and 6 weeks of rehabilitation treatment, the control tests were performed in the same way as in the initial test.

Results

Based on the values of MANOVA analysis and discriminative analysis, significantly better results of isokinetic tests were found in the examined group A-isokinetic compared with those in the examined group B-isotonic. At the final measurement of group A, 83 respondents (92.2%) were placed in the "biggest" class out of the 90 respondents.

Conclusion

Based on the obtained research results, we conclude that isokinetic exercise is more effective in terms of physiotherapy of quadriceps hypotrophy after knee surgery.

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

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.

Clinical Utility of Ultrasound Imaging for Measuring Anterior Thigh Thickness after Anterior Cruciate Ligament Injury in an Individual Patient to Assess Postsurgery Outcome

The present study investigated the clinical utility of ultrasound imaging (USI) for assessing changes in an individual's quadriceps muscle and subcutaneous fat (SF) thickness of the anterior thigh and their relative proportions. A patient was studied prior to and after anterior cruciate ligament reconstruction (ACLR) surgery and during rehabilitation. This case study involved an 18-year-old female recreational athlete with a complete tear of the anterior cruciate ligament (ACL). Tissue thickness (SF and quadriceps muscle) was measured from transverse USI of the anterior thigh before surgery, at weekly intervals during 12 weeks of postsurgery, and then every 2 weeks for the following 12 weeks (total of 21 measurement sets). Statistically significant differences presurgery to postrehabilitation were found for muscle thickness (p = 0.04) and SF tissue thickness (p = 0.04) measurements. There was no difference in muscle to fat ratio (p = 0.08). Changes in measurements greater than the reported minimal detectable change (MDC) demonstrate the sensitivity of the USI technique as an objective tool to assess clinically useful changes in an individual's anterior thigh muscle thickness post-ACLR surgery and during rehabilitation.

Association between quadriceps muscle thickness and knee function in anterior cruciate ligament reconstructed athletes: a cross-sectional study

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.

The temporal and spatial effects of reconstructive surgery on the atrophy of hindlimb muscles in anterior cruciate ligament transected rats

After anterior cruciate ligament (ACL) injury, a decrease in muscle strength associated with muscle atrophy is frequently observed. The temporal and spatial effects of reconstructive surgery on muscle atrophy have not been examined in detail. This study aimed to 1) reveal the short and mid-term effects of reconstructive surgery on muscle atrophy, and 2) investigate the differences in the degree of atrophy after ACL reconstruction in the hindlimb muscles. ACL transection with or without reconstructive surgery was performed unilaterally on the knees of rats. Untreated rats were used as controls. At one or four weeks post-surgery, the relative muscle wet weights (wet weight/body weight) of the hindlimb muscles were calculated to assess atrophy. At one week post-surgery, muscle atrophy was induced by ACL transection and further aggravated by reconstructive surgery. Reconstructive surgery facilitated recovery from muscle atrophy in some muscles compared with those without reconstructive surgery (ACL transection alone) at four weeks post-surgery. Muscle atrophy after ACL reconstruction was greater in the rectus femoris and plantar flexors than in the semitendinosus and plantar extensors at one week post-surgery. These results indicate that reconstructive surgery exacerbates muscle atrophy in the first week post-surgery, while facilitating recovery between the first and fourth week post-surgery. After reconstructive surgery, muscle atrophy was observed not only in the quadriceps and hamstrings, but also in the lower leg muscles, suggesting the need for muscle strengthening interventions for the lower leg muscles as well as the quadriceps and hamstrings.

Bilateral muscle atrophy after anterior cruciate ligament reconstruction in rats: Protective effects of anti-inflammatory drug celecoxib

BACKGROUND

Muscle atrophy after anterior cruciate ligament (ACL) reconstruction occurs bilaterally and contributes to a decrease in muscle strength. However, effective treatment strategies for ACL reconstruction-induced muscle atrophy have not been established. We examined the effects of anti-inflammatory drug on muscle atrophy after ACL reconstruction.

MATERIALS AND METHODS

Rats were divided into groups according to treatment received: untreated control (n = 4), arthrotomy (n = 6), ACL transection (n = 7), ACL reconstruction (n = 8), and ACL reconstruction plus anti-inflammatory drug celecoxib (CBX; 50 mg/kg/day) administration (n = 8). At one-week post-surgery, the muscle fiber cross-sectional area (CSA) in the rectus femoris (RF) and semitendinosus (ST) was measured to assess muscle atrophy. In addition, we examined joint swelling and serum C‑reactive protein (CRP) levels to assess local and systemic inflammation, respectively.

RESULTS

Each additional procedure (i.e., arthrotomy, ACL transection, and ACL reconstruction) gradually decreased the muscle fiber CSAs in the RF and ST on both operated and contralateral sides. The degree of muscle fiber atrophy on the operated side was larger than that detected on the contralateral side. Moreover, ACL reconstruction induced joint swelling on the operated side and tended to increase serum CRP levels. CBX lessened the RF atrophy on both sides and was associated with less joint swelling and a smaller increase CRP level; however, it did not affect ST atrophy on either side.

CONCLUSIONS

Anti-inflammatory treatments after ACL reconstruction may be effective in lessening muscle atrophy in the quadriceps, but not in the hamstrings.

Ultrasound Imaging of the Anterior Cruciate Ligament: A Pictorial Essay and Narrative Review

Ultrasound has been extensively applied to the diagnosis of and guided interventions for knee disorders. However, although it is commonly affected during sports injuries, the anterior cruciate ligament (ACL) is not usually incorporated in the majority of ultrasound scanning protocols. In the past, because of its oblique trajectory and deeper location, the ACL was considered to be a challenging structure for ultrasound imaging. Owing to advances in ultrasound technology and knowledge of knee sono-anatomy, an increasing number of studies are investigating the clinical value of ultrasound in the diagnosis and management of ACL injuries. In this regard, the present review aims to elaborate on the sono-anatomy of the ACL, to summarize the evidence for ultrasound imaging for ACL lesions and to investigate whether it is useful in the pre-operative preparation and post-operative follow-up of ACL reconstruction.