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Larsen B, Bellettiere J, Allison M, Ryu R, Tam RM, McClelland RL, Miljkovic I, Vella C, Ouyang P, Criqui M, Unkart J. Associations of Abdominal Muscle Density and Area and Incident Cardiovascular Disease, Coronary Heart Disease, and Stroke: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2024; 13:e032014. [PMID: 38348808 PMCID: PMC11010071 DOI: 10.1161/jaha.123.032014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Muscle density is inversely associated with all-cause mortality, but associations with cardiovascular disease (CVD) risk are not well understood. This study evaluated the association between muscle density and muscle area and incident total CVD, coronary heart disease (CHD), and stroke in diverse men and women. METHODS AND RESULTS Adult participants (N=1869) in the Multi-Ethnic Study of Atherosclerosis Ancillary Body Composition Study underwent computer tomography scans of the L2-L4 region of the abdomen. Muscle was quantified by density (Hounsfield units) and area in cm2. Sex-stratified Cox proportional hazard models assessed associations between incident total CVD, incident CHD, and incident stroke across sex-specific percentiles of muscle area and density, which were entered simultaneously into the model. Mean age for men and women at baseline were 64.1 and 65.1 years, respectively, and median follow-up time was 10.3 years. For men, associations between muscle density and incident CVD were inverse but not significant in fully adjusted models (P trend=0.15). However, there was an inverse association between density and CHD (P trend=0.02; HR, 0.26 for 95th versus 10th percentile), and no association with stroke (P trend=0.78). Conversely, for men, there was a strong positive association between muscle area and incident CVD (HR, 4.19 for 95th versus 10th percentile; P trend<0.001). Associations were stronger for CHD (HR, 6.18 for 95th versus 10th percentile; P trend<0.001), and null for stroke (P trend=0.67). Associations for women were mostly null. CONCLUSIONS For men, abdominal muscle density is associated with lower CHD risk, whereas greater muscle area is associated with markedly increased risk of CHD.
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Affiliation(s)
- Britta Larsen
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | - Matthew Allison
- Department of Family Medicine & Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Rita Ryu
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | - Rowena M. Tam
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | | | - Iva Miljkovic
- Department of EpidemiologyUniversity of PittsburgPAUSA
| | - Chantal Vella
- Department of Movement SciencesUniversity of IdahoBoiseIDUSA
| | - Pamela Ouyang
- Department of MedicineJohns Hopkins School of MedicineBaltimoreMDUSA
| | - Michael Criqui
- Department of Family Medicine & Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Jonathan Unkart
- Department of Family Medicine & Public HealthUniversity of California San DiegoSan DiegoCAUSA
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Gan H, Lan J, Bei H, Xu G. The impact of sarcopenia on prognosis of patients with pancreatic cancer: A systematic review and meta-analysis. Scott Med J 2023; 68:133-148. [PMID: 37448350 DOI: 10.1177/00369330231187655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To summarize recent findings on the association of low skeletal muscle mass and muscle quality with overall survival and recurrence-free survival in patients with pancreatic cancer. METHODS A systematic search was conducted using Medline (via PubMed), Embase and Scopus databases for observational studies reporting on the overall survival and recurrence-free survival. Pooled effect sizes were reported as hazards ratio along with 95% confidence intervals. RESULTS A total of 34 studies were included. Low skeletal muscle index (indicating muscle mass) was associated with poor overall survival (hazards ratio: 1.50; 95% confidence interval: 1.34, 1.67) and lower recurrence-free survival (hazards ratio: 1.28, 95% confidence interval: 1.15, 1.43). Low skeletal muscle attenuation (indicating muscle quality) was associated with poor overall survival (hazards ratio: 1.32; 95% confidence interval: 1.05, 1.66). Recurrence-free survival was similar in patients with low and normal/high skeletal muscle attenuation (hazards ratio: 1.12, 95% confidence interval: 0.89, 1.40). CONCLUSION Both low skeletal muscle mass and poor muscle quality are associated with poor long-term survival. Low skeletal muscle index, but not low skeletal muscle attenuation, are associated with poor recurrence-free survival.
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Affiliation(s)
- Hui Gan
- Department of Gastroenterology, Quzhou Second People's Hospital, Quzhou City, Zhejiang Province, China
| | - Jiarong Lan
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
- Department of Medicine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou City, Zhejiang Province, China
| | - Hongxia Bei
- Department of Endocrinology, Quhua Hospital, Quzhou City, Zhejiang Province, China
| | - Guangxing Xu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
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Ballinger TJ, Marques HS, Xue G, Hoffman R, Gatsonis C, Zhao F, Miller KD, Sparano J, Connolly RM. Impact of Muscle Measures on Outcome in Patients Receiving Endocrine Therapy for Metastatic Breast Cancer: Analysis of ECOG-ACRIN E2112. J Natl Compr Canc Netw 2023; 21:915-923.e1. [PMID: 37673107 PMCID: PMC10594540 DOI: 10.6004/jnccn.2023.7045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/06/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Observational data investigating the relationship between body habitus and outcomes in breast cancer have been variable and inconsistent, largely centered in the curative setting and focused on weight-based metrics. This study evaluated the impact of muscle measures on outcomes in patients with metastatic breast cancer receiving endocrine-based therapy. METHODS Baseline CT scans were collected from ECOG-ACRIN E2112, a randomized phase III placebo-controlled study of exemestane with or without entinostat. A CT cross-sectional image at the L3 level was extracted to obtain skeletal muscle mass and attenuation. Low muscle mass (LMM) was defined as skeletal muscle index <41 cm2/m2 and low muscle attenuation (LMA) as muscle density <25 HU or <33 HU if overweight/obese by body mass index (BMI). Multivariable Cox proportional hazard models determined the association between LMM or LMA and progression-free survival (PFS) and overall survival (OS). Correlations between LMM, LMA, and patient-reported outcomes were determined using 2-sample t tests. RESULTS Analyzable CT scans and follow-up data were available for 540 of 608 patients. LMM was present in 39% (n=212) of patients and LMA in 56% (n=301). Those with LMA were more likely to have obesity and worse performance status. LMM was not associated with survival (PFS hazard ratio [HR]: 1.13, P=.23; OS HR: 1.05, P=.68), nor was LMA (PFS HR: 1.01, P=.93; OS HR: 1.00, P=.99). BMI was not associated with survival. LMA, but not LMM, was associated with increased frequency of patient-reported muscle aches. CONCLUSIONS Both low muscle mass and density are prevalent in patients with hormone receptor-positive metastatic breast cancer. Muscle measures correlated with obesity and performance status; however, neither muscle mass nor attenuation were associated with prognosis. Further work is needed to refine body composition measurements and select optimal cutoffs with meaningful endpoints in specific breast cancer populations, particularly those living with metastatic disease.
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Affiliation(s)
| | | | - Gloria Xue
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Richard Hoffman
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Fengmin Zhao
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kathy D. Miller
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Joseph Sparano
- Icahn School of Medicine at Mount Sinai, New York, New York
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Tanaka M, Okada H, Hashimoto Y, Kumagai M, Nishimura H, Oda Y, Fukui M. Relationship between nonalcoholic fatty liver disease and muscle quality as well as quantity evaluated by computed tomography. Liver Int 2020; 40:120-130. [PMID: 31518481 DOI: 10.1111/liv.14253] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/08/2019] [Accepted: 09/09/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Sarcopenia is reported to be associated with nonalcoholic fatty liver disease (NAFLD). Evaluation of skeletal muscle attenuation and area by computed tomography (CT) may represent a promising approach for evaluation of the risk of NAFLD. We examined the association between skeletal muscle characteristics and NAFLD and investigated the combined effect of these parameters on the prevalence of NAFLD. METHODS In this cross-sectional study, we analysed data from 632 middle-aged Japanese subjects without daily alcohol intake (353 men and 279 women) from a cohort of employees undergoing annual health examinations. The cross-sectional skeletal muscle area was evaluated on the basis of CT data at the level of the third lumbar vertebrae, and the skeletal muscle index (SMI) and density (SMD) were calculated. The subjects were divided into four study groups according to their SMI and SMD relative to median values. RESULTS One hundred forty men and forty-three women had NAFLD. Total SMI (odds ratio [OR] per 1.0 cm2 /kg/m2 increase 0.43, 95% confidence interval [CI] 0.29-0.64 in men and OR 0.21, 95% CI 0.10-0.42 in women) and total SMD (OR, per 1.0 Hounsfield Unit increase 0.88, 95% CI 0.83-0.93 in men and 0.88, 0.82-0.95 in women) were significantly associated with the prevalence of NAFLD after adjusting for covariates. The subgroup with simultaneous presence of low SMI and low SMD was associated with a significantly higher prevalence of NAFLD compared with other groups. CONCLUSIONS Both SMI and SMD are independently associated with the prevalence of NAFLD.
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Affiliation(s)
- Muhei Tanaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hiroshi Okada
- Department of Internal Medicine, Matsushita Memorial Hospital, Osaka, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Muneaki Kumagai
- Medical Corporation Soukenkai, Nishimura Clinic, Kyoto, Japan
| | | | - Yohei Oda
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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McNamara KP, Greene KA, Moore AM, Lenchik L, Weaver AA. Lumbopelvic Muscle Changes Following Long-Duration Spaceflight. Front Physiol 2019; 10:627. [PMID: 31164840 PMCID: PMC6536568 DOI: 10.3389/fphys.2019.00627] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/02/2019] [Indexed: 12/25/2022] Open
Abstract
Long-duration spaceflight has been shown to negatively affect the lumbopelvic muscles of crewmembers. Through analysis of computed tomography scans of crewmembers on 4- to 6-month missions equipped with the interim resistive exercise device, the structural deterioration of the psoas, quadratus lumborum, and paraspinal muscles was assessed. Computed tomography scans of 16 crewmembers were collected before and after long-duration spaceflight. The volume and attenuation of lumbar musculature at the L2 vertebral level were measured. Percent changes in the lumbopelvic muscle volume and attenuation (indicative of myosteatosis, or intermuscular fat infiltration) following spaceflight were calculated. Due to historical studies demonstrating only decreases in the muscles assessed, a one-sample t test was performed to determine if these decreases persist in more recent flight conditions. Crewmembers on interim resistive exercise device-equipped missions experienced an average 9.5% (2.0% SE) decrease in volume and 6.0% (1.5% SE) decrease in attenuation in the quadratus lumborum muscles and an average 5.3% (1.0% SE) decrease in volume and 5.3% (1.6% SE) decrease in attenuation in the paraspinal muscles. Crewmembers experienced no significant changes in psoas muscle volume or attenuation. No significant changes in intermuscular adipose tissue volume or attenuation were found in any muscles. Long-duration spaceflight was associated with preservation of psoas muscle volume and attenuation and significant decreases in quadratus lumborum and paraspinal muscle volume and attenuation.
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Affiliation(s)
- Kyle P McNamara
- Center of Injury Biomechanics, Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, United States
| | - Katelyn A Greene
- Center of Injury Biomechanics, Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, United States
| | - Austin M Moore
- Center of Injury Biomechanics, Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, United States
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Ashley A Weaver
- Center of Injury Biomechanics, Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, United States
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De Amorim Bernstein K, Bos SA, Veld J, Lozano-Calderon SA, Torriani M, Bredella MA. Body composition predictors of therapy response in patients with primary extremity soft tissue sarcomas. Acta Radiol 2018; 59:478-484. [PMID: 28747130 DOI: 10.1177/0284185117723370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Recent studies have suggested that the quantity and quality of adipose tissue and muscle, assessed on non-contrast computed tomography (CT), may serve as imaging biomarkers of survival in patients with and without neoplasms. Purpose To assess body composition measures that could serve as predictors of therapy response in patients with extremity soft tissue sarcomas treated with radiation therapy and surgery. Material and Methods The study was IRB-approved. Sixty patients had a history of extremity soft tissue sarcoma and underwent FDG-PET/CT prior to radiation therapy and surgical resection. Cross-sectional areas and CT attenuation (HU) of abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and psoas muscle were assessed on non-contrast CT. Clinical information on predictors of tumor recurrence and post-surgical wound infections were recorded. Cox proportional hazard models were used to determine longitudinal associations between body composition and tumor recurrence/wound infections. Results Twenty-three tumor recurrences occurred over a follow-up period of 43 ± 35 months. Higher SAT and lower psoas attenuation were associated with tumor recurrence which remained significant after adjustment for covariates ( P ≤ 0.01). There were 13 post-surgical wound infections. Higher VAT and SAT attenuation were associated with post-surgical wound infections ( P < 0.04); however, VAT attenuation lost significance after adjustment for covariates. Conclusion Abdominal adipose tissue and psoas muscle attenuation assessed on non-contrast CT may predict tumor recurrence and post-surgical infections in patients with extremity soft tissue sarcomas.
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Affiliation(s)
- Karen De Amorim Bernstein
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stijn A Bos
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joyce Veld
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Santiago A Lozano-Calderon
- Musculoskeletal Oncology Service, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Abstract
BACKGROUND The storage of adipose tissue in ectopic compartments is a hallmark attribute linking greater body mass index (BMI) with cardiometabolic diseases. Despite ample evidence to confirm that increased visceral adipose tissue (VAT) deposition occurs with obesity, the interrelations between altered fat partitioning and regional muscle and bone quality are less well understood. OBJECTIVE We examined the association between adiposity and spinal muscle and bone quality across a large, heterogeneous cohort of adults. DESIGN We identified 8833 thoracic or abdominal computed tomography scans from patients in the University of Michigan Health System who were aged 18-64.9 y. We measured trabecular bone densities, cortical bone densities, VAT areas, and subcutaneous adipose tissue (SAT) areas at vertebral levels T7 to L5. Psoas muscle attenuation (an indicator of fat infiltration in muscle) was measured at the L4 level. RESULTS Muscle attenuation as well as trabecular and cortical bone densities revealed negative correlations with BMI, SAT, and VAT. The correlation between BMI and psoas attenuation was -0.321, between BMI and the density of cortical bone was -0.250, and between BMI and trabecular bone was -0.143 (all P < 0.001). However, correlations between VAT and lower muscle attenuation were stronger as were those between VAT and lower bone densities. Inverse correlations between VAT and densities of psoas muscle and cortical and trabecular bone were -0.460, -0.407, and -0.434, respectively (P < 0.001). Even after adjustment for age, sex, and BMI, partial correlations between VAT, muscle attenuation, and bone densities remained significant at -0.250, -0.119, and -0.216, respectively (P < 0.001). CONCLUSIONS Contrary to previous reports that high body mass is associated with increased bone quality, our data show a significant negative association between BMI and muscle and bone densities, suggesting fat infiltration into these tissues. More importantly, correlations between VAT and decreased bone and muscle densities remained statistically significant even after adjustment for age, sex, and BMI.
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Affiliation(s)
- Peng Zhang
- From the Departments of Surgery (PZ and SCW) and Physical Medicine and Rehabilitation (MP), VA Ann Arbor Healthcare System, Ann Arbor, MI, and the Department of Internal Medicine and Surgery (GLS), and the Morphomic Analysis Group (PZ, GLS, and SCW), University of Michigan, Ann Arbor, MI
| | - Mark Peterson
- From the Departments of Surgery (PZ and SCW) and Physical Medicine and Rehabilitation (MP), VA Ann Arbor Healthcare System, Ann Arbor, MI, and the Department of Internal Medicine and Surgery (GLS), and the Morphomic Analysis Group (PZ, GLS, and SCW), University of Michigan, Ann Arbor, MI
| | - Grace L Su
- From the Departments of Surgery (PZ and SCW) and Physical Medicine and Rehabilitation (MP), VA Ann Arbor Healthcare System, Ann Arbor, MI, and the Department of Internal Medicine and Surgery (GLS), and the Morphomic Analysis Group (PZ, GLS, and SCW), University of Michigan, Ann Arbor, MI
| | - Stewart C Wang
- From the Departments of Surgery (PZ and SCW) and Physical Medicine and Rehabilitation (MP), VA Ann Arbor Healthcare System, Ann Arbor, MI, and the Department of Internal Medicine and Surgery (GLS), and the Morphomic Analysis Group (PZ, GLS, and SCW), University of Michigan, Ann Arbor, MI
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Aubrey J, Esfandiari N, Baracos VE, Buteau FA, Frenette J, Putman CT, Mazurak VC. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol (Oxf) 2014; 210:489-97. [PMID: 24393306 PMCID: PMC4309522 DOI: 10.1111/apha.12224] [Citation(s) in RCA: 446] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/28/2013] [Accepted: 12/30/2013] [Indexed: 12/11/2022]
Abstract
Skeletal muscle contains intramyocellular lipid droplets within the cytoplasm of myocytes as well as intermuscular adipocytes. These depots exhibit physiological and pathological variation which has been revealed with the advent of diagnostic imaging approaches: magnetic resonance (MR) imaging, MR spectroscopy and computed tomography (CT). CT uses computer-processed X-rays and is now being applied in muscle physiology research. The purpose of this review is to present CT methodologies and summarize factors that influence muscle radiation attenuation, a parameter which is inversely related to muscle fat content. Pre-defined radiation attenuation ranges are used to demarcate intermuscular adipose tissue [from −190 to −30 Hounsfield units (HU)] and muscle (−29 HU to +150 HU). Within the latter range, the mean muscle radiation attenuation [muscle (radio) density] is reported. Inconsistent criteria for the upper and lower HU cut-offs used to characterize muscle attenuation limit comparisons between investigations. This area of research would benefit from standardized criteria for reporting muscle attenuation. Available evidence suggests that muscle attenuation is plastic with physiological variation induced by the process of ageing, as well as by aerobic training, which probably reflects accumulation of lipids to fuel aerobic work. Pathological variation in muscle attenuation reflects excess fat deposition in the tissue and is observed in people with obesity, diabetes type II, myositis, osteoarthritis, spinal stenosis and cancer. A poor prognosis and different types of morbidity are predicted by the presence of reduced mean muscle attenuation values in patients with these conditions; however, the biological features of muscle with these characteristics require further investigation.
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Affiliation(s)
- J. Aubrey
- Faculty of Physical Education and Recreation University of Alberta Edmonton AB Canada
| | - N. Esfandiari
- Department of Oncology University of Alberta Edmonton AB Canada
| | - V. E. Baracos
- Department of Oncology University of Alberta Edmonton AB Canada
| | - F. A. Buteau
- Department of Oncology University of Alberta Edmonton AB Canada
| | - J. Frenette
- Département de Réadaptation Faculté de Médecine Centre Hospitalier Universitaire de Québec–Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ‐CRCHUL) Université Laval Quebec City Quebec City QC Canada
| | - C. T. Putman
- Faculty of Physical Education and Recreation University of Alberta Edmonton AB Canada
| | - V. C. Mazurak
- Division of Human Nutrition University of Alberta Edmonton AB Canada
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Lindström M, Strandberg S, Wredmark T, Felländer-Tsai L, Henriksson M. Functional and muscle morphometric effects of ACL reconstruction. A prospective CT study with 1 year follow-up. Scand J Med Sci Sports 2011; 23:431-42. [PMID: 22107159 DOI: 10.1111/j.1600-0838.2011.01417.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2011] [Indexed: 02/06/2023]
Abstract
Computed tomography (CT) was used to explore if changes in muscle cross-sectional area and quality after anterior cruciate ligament (ACL) injury and reconstruction would be related to knee function. Fourteen females and 23 males (16-54 years) underwent clinical tests, subjective questionnaires, and CT 1 week before and 1 year after ACL surgery with semitendinosus-gracilis (STG) graft and rehabilitation. Postoperatively, knee laxity was decreased and functional knee measures and subjective patient scores improved. The most obvious remaining deficit was the quadriceps atrophy, which was significantly larger if the right leg was injured. Right-leg injury also tended to cause larger compensatory hypertrophy of the combined knee flexor and tibial internal rotator muscles (preoperatively). The quadriceps atrophy was significantly correlated with the scores and functional tests, the latter also being related to the remaining size of the gracilis muscle. Biceps femoris hypertrophy and, in males only, semimembranosus hypertrophy was observed following the ACL reconstruction. The lack of semimembranosus hypertrophy in the women could, via tibial internal rotation torque deficit, contribute to the less favorable functional and subjective outcome recorded for the women. The results indicate that the quadriceps, the combined knee flexor/tibial internal rotator muscles, side of ACL injury, and sex are important to consider in rehabilitation after STG graft.
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Affiliation(s)
- M Lindström
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden.
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