Effect of Subcutaneous Tissue on Changes in Thigh Circumference Following Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 40 (08) ◽  
pp. 544-550
Author(s):  
Ryo Yoshii ◽  
Yu Konishi ◽  
Daisuke Ando ◽  
Satoshi Ochiai ◽  
Tetsuo Hagino ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Cruciate Ligament ◽  
Subcutaneous Fat ◽  
Quadriceps Muscle ◽  
Thigh Circumference ◽  
Cross Sectional ◽  
Short Period ◽  
Anterior Cruciate ◽  
Muscle Cross Sectional Area ◽  
The Relationship

AbstractCircumference measurements have been used to estimate muscle cross-sectional area (CSA) in clinical settings. Measurements of thigh circumference are affected by muscle and subcutaneous fat (SF). In fact, SF could increase over a short period. Therefore, clarifying the relationship between thigh circumference and muscle and SF following ACL reconstruction is important. This study’s primary purpose was to examine pre- and post-operative changes in thigh circumference, thigh muscles and SF CSAs in both legs. Secondary, the relationship between thigh circumference and muscle and SF CSAs was examined to demonstrate that circumference measurements could be used to detect atrophy. Quadriceps, hamstrings, and SF CSAs at 15, 10, and 5 cm proximal to the patella were measured by MRI pre- and 4 weeks postoperatively to examine how reconstruction affected those tissues in the thighs. The results showed increases in SF CSA (r=0.72 at 10 cm, r=0.67 at 15 cm) greatly affected thigh circumference in females on the surgical side. In males, increases in SF CSA (r=0.83) at 15- and 5-cm and decreases in quadriceps muscle CSA (r=0.73) at 5 cm affected thigh circumference on the surgical side. Thigh circumference measurements might not reflect actual muscle CSA in ACL patients.

scholarly journals Quadriceps Recovery After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Versus Patellar Tendon Autografts

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983978 ◽  
Author(s):  
Jennifer L. Hunnicutt ◽  
Chris M. Gregory ◽  
Michelle M. McLeod ◽  
Shane K. Woolf ◽  
Russell W. Chapin ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Quadriceps Tendon ◽  
Step Length ◽  
Quadriceps Muscle ◽  
Muscle Size ◽  
Cross Sectional ◽  
Anterior Cruciate

Background: Quadriceps tendon (QT) autografts are being increasingly used for anterior cruciate ligament reconstruction (ACLR). A paucity of studies exist that compare QT autografts with alternative graft options. Additionally, concerns exist regarding quadriceps recovery after graft harvest insult to the quadriceps muscle-tendon unit. Purpose/Hypothesis: The purpose of this study was to compare quadriceps recovery and functional outcomes in patients with QT versus bone–patellar tendon–bone (BPTB) autografts. The hypothesis was that those with QT autografts would demonstrate superior outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Active patients with a history of primary, unilateral ACLR with soft tissue QT or BPTB autografts participated. Quadriceps recovery was quantified using variables of strength, muscle size, and activation. Knee extensor isometric and isokinetic strength was measured bilaterally with an isokinetic dynamometer and normalized to body weight. Quadriceps activation was measured with the superimposed burst technique. The maximal cross-sectional area of each quadriceps muscle was measured bilaterally using magnetic resonance imaging. Assessors of muscle size were blinded to the graft type and side of ACLR. Functional tests included hop tests and step length symmetry during walking, measured via spatiotemporal gait analysis. Self-reported function was determined with the International Knee Documentation Committee (IKDC) questionnaire. Neuromuscular and functional outcomes were expressed as limb symmetry indices (LSIs: [surgical limb/nonsurgical limb]*100%). Wilcoxon rank-sum tests were used to compare the LSIs and IKDC scores between groups. Results: There were 30 study participants (19 male, 11 female; median age, 22 years [range, 14-41 years]; median time since surgery, 8 months [range, 6-23 months]), with 15 patients in each group. There were no significant between-group differences in demographic variables or outcomes. LSIs were not significantly different between the QT versus BPTB group, respectively: knee extensor isokinetic strength at 60 deg/s (median, 70 [range, 41-120] vs 68 [range, 37-83]; P = .285), activation (median, 95 [range, 85-111] vs 92 [range, 82-105]; P = .148), cross-sectional area of the vastus medialis (median, 79 [range, 62-104] vs 77 [range, 62-95]; P = .425), single-leg hop test (median, 88 [range, 35-114] vs 77 [range, 49-100]; P = .156), and step length symmetry (median, 99 [range, 93-104] vs 98 [range, 92-103]; P = .653). The median IKDC scores between the QT and BPTB groups were also not significantly different: 82 (range, 67-94) versus 83 (range, 54-94); respectively ( P = .683). Conclusion: Patients with QT autografts demonstrated similar short-term quadriceps recovery and postsurgical outcomes compared with patients with BPTB autografts.

scholarly journals Healthy Pediatric Athletes Have Significant Baseline Limb Asymmetries on Common Return-to-Sport Physical Performance Tests

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712098230
Author(s):  
John R. Magill ◽  
Heather S. Myers ◽  
Trevor A. Lentz ◽  
Laura S. Pietrosimone ◽  
Thomas Risoli ◽  
...  
Keyword(s):  
Physical Performance ◽  
Pediatric Population ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Cross Sectional Study ◽  
Performance Tests ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Anterior Cruciate ◽  
The Relationship

Background: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction in children is associated with a much higher risk (∼30%) of subsequent ACL injury than in adults. Most RTS testing protocols use a limb symmetry index (LSI) ≥90% on physical performance tests (PPTs) to assess an athlete’s readiness for sport. This assumes that, in a healthy state, the physical performances across both lower extremities are and should be equal. Purpose: To determine the prevalence of limb asymmetries >10% in the uninjured pediatric population on common PPTs as well as to explore the relationship between athlete variables, limb preference, and LSI values. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included healthy volunteers (N = 100) evenly distributed between the ages of 6 and 18 years (mean age, 11.7 ± 3.6 years; 52% female). Participants performed 9 common PPTs. For analysis, we developed a composite score for each limb by averaging trials. We then calculated the LSI for each test. Univariable and multivariable linear regression analyses were performed to assess the relationship between athlete variables (age, sex, height, and weight) and LSI for each PPT. Results: Instances of poor baseline limb symmetry (<90% LSI) were common across all PPTs. The single-leg timed hop had the highest percentage of participants, with LSI ≥90% at 73%, while the stork on a Bosu ball had the lowest percentage at 23%. After adjusting for age, female sex showed a significant association with LSI for the stork test ( P = .010) and the quadrant hop–counterclockwise ( P = .021). Additionally, after adjusting for sex, increasing age showed a significant association with LSI for the stork test ( P < .001), single-leg squat on a Bosu ball ( P = .010), quadrant hop–clockwise ( P = .016), and quadrant hop–counterclockwise ( P = .009). Conclusion: The majority of healthy athletes 18 years and younger demonstrated significant (<90%) limb asymmetries. Limb symmetry was not consistently affected by participant age or sex, and the effect sizes of these relationships were small. These findings should encourage clinicians and coaches to exercise caution in using the LSI as an isolated measure of RTS readiness after injury in pediatric athletes.

Significance of the Single-Legged Hop Test to the Anterior Cruciate Ligament-Reconstructed Knee in Relation to Muscle Strength and Anterior Laxity

1998 ◽  
Vol 26 (3) ◽  
pp. 384-388 ◽  
Author(s):  
Ichiro Sekiya ◽  
Takeshi Muneta ◽  
Takashi Ogiuchi ◽  
Kazuyoshi Yagishita ◽  
Haruyasu Yamamoto
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Cruciate Ligament ◽  
Quadriceps Muscle ◽  
Strength Recovery ◽  
Anterior Laxity ◽  
Hop Test ◽  
Anterior Cruciate ◽  
Knee Muscle ◽  
The Relationship

We investigated the significance of the single-legged hop test to the anterior cruciate ligament-reconstructed knee as it specifically relates to knee muscle strength recovery and residual anterior laxity. The hop test was conducted on 107 patients with unilateral anterior cruciate ligament-reconstructed knees (78 semitendinosus tendon autografts and 29 bone-patellar tendon-bone autografts). Patients were tested an average of 2 years after surgery. Correlation coefficient analyses determined whether the relationship between knee muscle strength recovery and the hop test was invariant across all levels of residual anterior laxity and whether the relationship between residual anterior laxity and the hop test was invariant across levels of quadriceps muscle strength recovery. Furthermore, we examined the effect of graft harvest site on the hop index. Positive correlations were found between the hop index and muscle strength index at all levels of residual anterior laxity (P 0.05), but these correlation coefficients were relatively low. There were no apparent correlations between the hop index and residual anterior laxity at all levels of quadriceps muscle strength recovery. There was no significant difference in the average hop index between the semitendinosus tendon autograft group and the bone-patellar tendon-bone autograft group.

scholarly journals Early Quadriceps Wasting after Anterior Cruciate Ligament Reconstruction in Young Adults: A Prospective Study

2021 ◽  
Author(s):  
Shubham Agarwal ◽  
Hemant Jain ◽  
Kishore Raichandani ◽  
Jagdish Godara ◽  
Sunil Choudhary
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Quadriceps Muscle ◽  
Thigh Circumference ◽  
Femur Length ◽  
Acl Tear ◽  
Measuring Tape ◽  
Anterior Cruciate ◽  
Prospective Longitudinal

Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the knee that requires surgical intervention. The weakness of quadriceps muscle is a sequele of ACL tear that can persist even after reconstruction. Muscle wasting if identified in early postoperative period can help to formulate structured protocols for rehabilitation that can help patient to recover. Best available method for scan of the same includes Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan, but it is neither accessible nor affordable to masses of population. Aim: To evaluate the quadriceps thickness using an easily available modality i.e., Ultrasonography (USG) and thigh circumference to detect early wasting. Materials and Methods: This prospective longitudinal study was done on 48 patients between the ages of 18-45 years with ACL tear operated arthroscopically. After six months of surgery, all patients were evaluated for quadriceps thickness using USG and thigh circumference using traditional measuring tape at the same points. Paired t-test was used for evaluation of the results. Results: This study quantifies quadriceps thickness using USG at two distinct levels of the thigh and found a significant deficit of 13.05% in the involved extremity at 1/3rd of femur length from knee joint and a deficit of 11.72% in involved extremity at 2/3rd of femur length from knee joint. This study established that the quadriceps of the involved extremity definitely goes under atrophy despite early rehabilitation. Also, there was a deficit of 5.04% in thigh circumference at 1/3rd of femur length from knee joint and 4.43% at 2/3rd of femur length from knee joint in the operated limb. There was no positive correlation between both the methods. Conclusion: This study concluded that USG is an easily available and affordable method to determine quadriceps thickness and it’s wasting early in the postoperative rehabilitation phase. It can assist in establishing early vigorous rehabilitation protocols. The traditional method of measuring thigh circumference using measuring tape to quantify quadriceps muscle bulk can be misleading as its underestimates the atrophy due to various factors.

Predictive Factors for Hamstring Autograft Diameter in Anterior Cruciate Ligament Reconstruction

2019 ◽  
Author(s):  
Willem M.P. Heijboer ◽  
Mathijs A.M. Suijkerbuijk ◽  
Belle L. van Meer ◽  
Eric W.P. Bakker ◽  
Duncan E. Meuffels
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Model ◽  
Gracilis Tendon ◽  
Thigh Circumference ◽  
Anterior Cruciate

AbstractMultiple studies found hamstring tendon (HT) autograft diameter to be a risk factor for anterior cruciate ligament (ACL) reconstruction failure. This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thigh circumference were all significantly correlated with HT autograft diameter (p < 0.05). A multiple linear regression model with CSA measurement of the HTs on MRI, weight, and height showed the most explained variance of HT autograft diameter (adjusted R 2 = 44%). A regression equation was derived for an estimation of the expected intraoperative HT autograft diameter: 1.2508 + 0.0400 × total CSA (mm2) + 0.0100 × weight (kg) + 0.0296 × length (cm). The Bland and Altman analysis indicated a 95% limit of agreement of ± 1.14 mm and an error correlation of r = 0.47. Smaller CSA of the semitendinosus and gracilis tendon on MRI, shorter stature, lower weight, smaller thigh circumference, and female gender are associated with a smaller four-stranded HT autograft diameter in ACL reconstruction. Multiple linear regression analysis indicated that the combination of MRI CSA measurement, weight, and height is the strongest predictor.

Effects of Anterior Cruciate Ligament (ACL) Injury on Muscle Activity of Head, Neck and Trunk Muscles: A Cross-Sectional Evaluation

CRANIO® ◽  
2007 ◽  
Vol 25 (3) ◽  
pp. 177-185 ◽  
Author(s):  
Simona Tecco ◽  
Vincenzo Salini ◽  
Stefano Teté ◽  
Felice Festa ◽  
Christian Colucci
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Activity ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Trunk Muscles ◽  
Cross Sectional ◽  
Anterior Cruciate ◽  
Head Neck
Sign in / Sign up

Export Citation Format

Share Document