Quadriceps Research Articles

Exploring the Utility of Curvilinear Feedback Systems for Improving Muscle Strength via Surface Electromyography

Our knees play a crucial role in our everyday lives and mobility; however, their constant usage leads to life-changing injuries such as osteoarthritis and ligament tears. Recent advancements in knee-related interventions have focused on enhancing the recovery process, with a particular emphasis on the Vastus Medialis Oblique (VMO), a quadricep muscle pivotal for knee stability. The strengthening of this muscle can be beneficial for those recovering from knee-related injuries. Utilizing surface electromyography (sEMG) to measure muscle contractions, behavior analysts can provide feedback and establish contingencies for promoting stronger VMO contractions. While previous studies have worked with discrete schedules of reinforcement, this study utilizes conjugate schedules that mirror real-world contingencies. We compare two types of curvilinear relations in the conjugate schedule, influencing the relation between muscle response and feedback. In one condition, a negatively accelerating relation was created, where low to moderate muscle contractions produced the greatest amount of reinforcement. The other arrangement featured a positively accelerating relation, where highly intense contractions would be reinforced the most. Results showed that all eight participants had their strongest contractions under the positively accelerating relation. Six of them also demonstrated higher average amplitudes within that same condition, providing valuable insight into the efficacy of curvilinear relations in shaping VMO contractions.

Evaluation of the efficacy of transfer energy capacitive and resistive therapy in patients with knee osteoarthritis.

This study aimed to compare the therapeutic efficacy of conventional physical therapy (CPT) methods for knee osteoarthritis (OA) and transfer energy capacitive and resistive (TECAR) therapy, a relatively new and increasingly used treatment modality, based on patient clinical outcomes assessments. Two groups of 54 patients, aged 40 to 75, were randomly assigned. CPT was given to both groups. In addition to CPT, Group 2 underwent TECAR therapy for six sessions, three times a week for two weeks. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to measure the disability and pain levels of each patient before and at the end of treatment and at 1 month and 3 months. Additionally, goniometric measurements of each patient's knee joint range of motion and isometric quadriceps muscle strength were taken. Significant improvements were noted in the VAS, WOMAC, and isometric quadriceps strength ratings in both groups between the pre- and posttreatment follow-ups. However, there was no discernible difference between the groups. For the conservative treatment of OA in the knee, TECAR therapy may be a helpful therapeutic approach.

Assessment of Age-Related Microstructure Changes in Thigh Skeletal Muscle Based on Neurite Orientation Dispersion and Density Imaging.

Neurite orientation dispersion and density imaging (NODDI) could offer information about the morphological properties of tissue. Diffusion microstructure imaging has been widely used, but the applicability of NODDI in skeletal muscle imaging remains to be explored. To evaluate microstructure parameters variations in skeletal muscle as indicators of age-related changes. Prospective, cross-sectional. A total of 108 asymptomatic volunteers, divided into three age groups: 20-39 years (N = 34), 40-59 years (N = 40), and over 60 years (N = 34). 3-T, three-dimensional (3D) gradient echo sequence. T1-weighted imaging, T2-weighted imaging with spectral adiabatic inversion recovery, and NODDI were used to image the thigh skeletal muscles. Four thigh skeletal muscle groups were analyzed, including bilateral thigh quadriceps femoris and hamstrings. The microstructure parameters included orientation dispersion index (ODI), intra-myofibrillar water volume fraction (V-intra), free-water fraction (V-csf), fractional anisotropy (FA), and mean diffusivity (MD). These parameters were quantified using NODDI images and compared among different age, body mass index (BMI), and skeletal muscle index (SMI) subgroups. Segmentation measurement reliability was assessed using a two-way mixed intraclass correlation coefficient (ICC). Shapiro-Wilk tests were used to assess data distribution. Kruskal-Wallis and Mann-Whitney U tests were used to compare ODI, V-intra, V-csf, FA, and MD values among different age, BMI, and SMI subgroups. The Spearman correlation coefficient was utilized to assess the strength of the correlation between the age and microstructure parameters, as well as between age and SMI. Additionally, Bonferroni post hoc tests were conducted on microstructure parameters that exhibited significant differences across various age groups. A P-value <0.05 was considered statistically significant. Significant differences in ODI, V-csf, FA, and MD values were observed among age, BMI, and SMI subgroups. NODDI may be used to reveal information about microstructure integrity and local physiological changes of thigh skeletal muscle fibers in relation to age. 2 TECHNICAL EFFICACY: Stage 2.

The effect of fatiguing muscle contractions on kicking performance in experienced soccer players

ABSTRACT The objective of this study was to clarify the effects of fatiguing muscle contractions of the m. quadriceps femoris on kicking abilities of experienced soccer players. 16 male professional (n = 5) and amateur players (n = 11) performed kicking tests in two conditions (fatigue and control) on separate days in a randomised crossover design. The fatiguing protocol performed with the kicking leg consisted of 5 sets of 10 maximal voluntary concentric and eccentric knee extensions. Maximal voluntary isometric contraction force (MVIC), 15 hz/50 hz stimulation force ratio (force ratio), and kicking abilities were assessed before and after completion of the fatiguing protocol or rest (control). The fatiguing protocol successfully induced fatigue of 14.0 ± 2.7% (mean ± SE) reduced MVIC and 14.0 ± 3.7% reduced force ratio while no reductions occurred in the control condition. Between group difference showed ball speed declined 2.1 ± 0.95% more following the fatigue protocol compared to control condition. On the control day shooting accuracy improved by 13.3 ± 5.6% and was numerically impaired on the intervention day by 1.0 ± 9.2%. Despite this, no significant between group difference was observed in shooting accuracy (p = 0.18). The study demonstrated that fatigue induced by prior muscle contractions impairs maximal shooting speed, but we observed no significant impairment of shooting accuracy.

Comparison of the Effect of High-Intensity Laser Therapy and Quadriceps Muscle Strengthening Exercises Using Biofeedback on Pain, Stiffness and Function of Patients with Knee Osteoarthritis: A Randomized Clinical Trial

Objectives: This study aims to compare the effects of high-intensity laser therapy (HILT) and quadriceps muscle strengthening exercises using biofeedback on pain and function in patients with knee osteoarthritis (KOA). Methods: This randomized, two-group clinical trial included patients with KOA (grades II - III of the Lawrence Kellgren classification) who met the inclusion criteria. Written informed consent was obtained from participants before they were randomly allocated into one of two groups: HILT + therapeutic exercise (group A) or quadriceps muscle strengthening exercises using biofeedback + therapeutic exercise (group B). Both groups followed the same therapeutic exercise regimen during the study. Knee pain severity was evaluated using the Visual Analogue Scale (VAS), and functional disability was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire before the intervention. For group A, HILT was performed using a BTL-6000 HIL device (wavelength 1064 nm, maximum power 12 W) following the manufacturer-recommended protocol. A pain relief program (10 W, 120 J/cm²) was administered for 120 seconds per session over ten sessions. Treatment protocol, laser positioning, and session duration were standardized. Two follow-up assessments (immediately and one-month post-intervention) were conducted to evaluate outcomes based on the VAS and WOMAC scores. Results: The study included 40 participants with KOA, divided evenly between the two groups (20 in each). The average age of the participants was 59.34 ± 6.92 years. High-intensity laser therapy group (group A): Visual analogue scale pain scores decreased significantly immediately after and one month post-intervention compared to baseline (P &lt; 0.01). However, the VAS score one month after the intervention showed no significant difference compared to the immediate post-intervention score (P = 0.59). Biofeedback group (group B): VAS pain scores also decreased significantly both immediately after and one month post-intervention compared to baseline (P &lt; 0.05). The difference in VAS pain reduction between the two groups was significant, with the HILT group showing greater improvement immediately after the intervention and one month later (P = 0.007). Conclusions: The study findings suggest that both quadriceps muscle strengthening exercises using biofeedback and HILT effectively reduce pain in KOA patients. However, HILT demonstrated superior efficacy compared to biofeedback exercises. These results support the use of HILT as a noninvasive therapeutic modality for KOA, particularly for patients with a higher risk of surgery due to preexisting comorbidities.

The utility and safety of one-minute sit-to-stand test in pulmonary hypertension: A prospective study

BackgroundFunctional exercise capacity in pulmonary hypertension (PH) is routinely assessed using the 6-min walking test (6MWT). However, alternative tests are useful because of resource requirements. This study aimed to evaluate whether the 1-min sit-to-stand test (1STST) is useful and safe in PH and whether it can replace the 6MWT. MethodsAdult patients with PH were recruited from our hospital between September 2023 and April 2024. The correlations between the number of 1STST repetitions (1STSTr) and 6-min walk distance (6MWD), pulmonary hemodynamic parameters, and quadriceps muscle strength; adverse events; and vital sign fluctuations during the tests were evaluated, and a questionnaire with an 11-point Likert scale (−5, 6MWT favor; 5, 1STST favor) was administered. ResultsTwenty-one patients with PH were enrolled in this study. The 1STSTr and 6MWD were 23.8 ± 7.8/min and 425.8 ± 116.8 m, respectively, with a strong correlation (r = 0.771). 1STSTr was significantly correlated with brain natriuretic peptide, but not with other pulmonary hemodynamic markers, respiratory function, or quadriceps muscle strength. No serious adverse events or motor impairments occurred with the 1STST.The minimum SpO2 during the tests was significantly lower with the 6MWT (92.6 ± 3.1 vs. 88.0 ± 11.0). The questionnaire showed a predominant preference for the 1STST (3.2 ± 2.6). ConclusionsTo our knowledge, this is the first study in Japan to adapt the 1STST to PH patients. The 1STST is a reliable alternative to the 6MWT for measuring exercise capacity in PH patients. Trial registrationThis study was registered with the UMIN-CTR (number UMIN000052010).

Assessment of Quadriceps Muscle in Advanced Knee Osteoarthritis and Correlation with Lower Limb Alignment

Background and Objectives: Despite extensive studies of the role of quadriceps and quadriceps/hamstring balance in knee osteoarthritis (OA), the roles of the vastus intermedius, medialis, and lateralis in OA remain unclear. The purpose of this study was to investigate the relationship of lower limb alignment and the ratio of the quadriceps femoris muscle to the knee extensor muscle. Materials and Methods: This study included 50 patients with advanced knee OA (Kellgren/Lawrence grade of 3 or 4) and 25 healthy control persons between June 2021 and May 2022. The osteoarthritis grade and anatomical tibiofemoral angle were measured based on plain radiography and scanography. All participants were divided into normal (0~5°), mild varus (5°~10°), and severe varus (&gt;10°) groups. Using MRI, muscle size was determined by calculating the cross-sectional area (CSA) of the total quadriceps (rectus femoris, vastus intermedius, vastus medialis, and vastus lateralis) and its components. Results: The CSA ratio of the vastus lateralis was significantly smaller in the severe varus group than in the normal or mild varus groups. There was a significant positive correlation between the mechanical tibiofemoral angle and vastus lateralis CSA (ρ = 0.282, p = 0.014) and between the anatomical tibiofemoral angle and vastus lateralis CSA (ρ = 0.294, p = 0.011). There was a significant negative correlation between the mechanical tibiofemoral angle and vastus intermedius CSA (ρ = −0.263, p = 0.023) and between the anatomical tibiofemoral angle and vastus intermedius CSA (ρ = −0.243, p = 0.036). Conclusions: Patients with severe varus alignment exhibited vastus lateralis atrophy. This study highlights vastus lateralis atrophy in severe varus alignment, though causality between atrophy and varus knee OA remains uncertain. We think that patients with severe varus may require strengthening exercises focused on the vastus lateralis before and after surgery for alignment correction.

Advancing Recovery by Incorporating Physiological Insights into the Surgical Management of Chronic Proximal Rectus Femoris Tendon Avulsion

Background: Tendon lesions affecting the proximal rectus femoris (PRF) muscle represent about 1.5% of hip injuries. Most acute cases are managed conservatively with physiotherapy. There is a lack of consensus regarding surgical intervention for chronic injuries. This article, alongside a literature review, presents a case of anatomical surgical reinsertion for chronic complete avulsion rupture of the PRF tendon. Case Report: A 34-year-old amateur athlete experienced acute inguinal pain from overexertion, with conservative treatment having failed over 3 months. Seven months later, proximal tendon rupture involving both PRF muscle heads was confirmed. An anterior Hueter approach released the tendon from the adhesions and fibrosis. The direct portion was reinserted into the inferior anterior iliac spine, and the reflex portion was reattached to the supraacetabular groove. The patient showed excellent improvement on the modified Harris Hip and Lysholm–Tegner scales. The quadriceps muscle force decreased by 20% compared to the contralateral leg at 3 months, reducing to 4% by 12 months. Normal activities resumed after six weeks, and sports resumed after 4 months. Conclusions: The patient experienced significant postoperative improvement, as shown by the enhanced functional scores and muscle force recovery over one year. The success of the anatomical reconstruction in restoring tendon continuity underscores the importance of tendon healing mechanisms, including tissue remodeling and revascularization, in chronic avulsion injuries. This case highlights the efficacy of anatomical reconstruction for chronic PRF tendon avulsion. The literature review offers further insights into treatment options and the physiological basis of recovery for such injuries.

Effects of Low-Load Blood Flow Restriction Training on Muscle Volume After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

After anterior cruciate ligament (ACL) reconstruction (ACLR), the function and strength of the quadriceps muscle are essential for a successful recovery. Low-load blood flow restriction training (LL-BFRT) is believed to reduce muscle atrophy and restore muscle function. To systematically analyze the evidence on the effectiveness of LL-BFRT in early rehabilitation after ACLR. Systematic review; Level of evidence, 1. A systematic review and meta-analysis were conducted consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Comprehensive literature searches were performed in several electronic databases-including Cochrane Library (trials), PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database, and Sinomed-from inception to October 1, 2023. Included were randomized controlled trials in Chinese and English comparing LL-BFRT within 6 weeks after ACLR with conventional rehabilitation training. Bias risk was assessed using the Cochrane Risk-of-Bias 2 tool. The outcomes measured were quadriceps muscle size, knee joint functional scores, balance function, and complications. The effects of LL-BFRT versus conventional rehabilitation were analyzed using standardized mean differences (SMDs) or weighted mean differences (WMDs). A total of 362 studies were initially identified, and 8 were included for analysis. LL-BFRT was significantly more effective in improving quadriceps muscle volume (SMD, 0.37 [95% CI, 0.08 to 0.66]; P = .01) and Lysholm scores (SMD, 0.74 [95% CI, 0.43 to 1.05]; P < .0001) compared with conventional rehabilitation training. However, no significant improvements were observed in the 3 directions of the Y-balance test: anterior (WMD, 0.55 [95% CI, -6.37 to 7.46]; P = .88), posteromedial (WMD, -2.24 [95% CI, -8.76 to 4.29]; P = .50), and posterolateral (WMD, 0.02 [95% CI, -13 to 13.03]; P = 1.0). No complications were reported in any of the included studies. The results of this meta-analysis suggested that LL-BFRT within 6 weeks after ACLR has a more pronounced effect on increasing quadriceps muscle volume and improving Lysholm scores compared with conventional rehabilitation training, with no apparent complications.

Impact of low-dose sevoflurane with propofol-based anesthesia on motor-evoked potentials in infants: a single-arm crossover pilot study

Abstract Purpose The influence of anesthetic interactions on motor-evoked potentials in infants has rarely been reported. In infants, adding a small dose of sevoflurane to propofol-based total intravenous anesthesia is reasonable for reducing propofol administration. We collected preliminary data regarding the effect of low-dose sevoflurane in propofol-based total intravenous anesthesia on motor-evoked potentials in infants. Methods This pilot interventional study included 10 consecutive infants requiring motor-evoked potentials between January 2023 and March 2024. The motor-evoked potential amplitudes in the upper and lower extremities were recorded twice when general anesthesia was maintained using (1) propofol-based total intravenous anesthesia and (2) 0.1–0.15 age-adjusted minimum alveolar concentration sevoflurane + propofol-based total intravenous anesthesia. Results The motor-evoked potential amplitude in the right upper extremity was not significantly different after the addition of a small dose of sevoflurane [192 (75.3–398) μV, 121 (57.7–304) μV, P = 0.19]. All the motor-evoked potential amplitudes in the right lower extremity (quadriceps femoris, anterior tibialis, and gastrocnemius muscles) were significantly attenuated by adding a small dose of sevoflurane (median [interquartile range]: 47.9 [35.4–200] μV, 25.2 [12.4–55.3] μV, P = 0.014; 74.2 [51.9–232] μV, 31.2 [2.7–64] μV, P = 0.0039; 29.8 [20–194] μV, 9.9 [3.8–92.4] μV, P = 0.0039, respectively). Similar results were observed in the left lower extremities. Conclusion Adding even 0.1–0.15 age-adjusted minimum alveolar concentration sevoflurane to propofol-based total intravenous anesthesia attenuated the motor-evoked potential amplitudes in the lower extremities. A further prospective interventional study with an appropriate sample size is required to investigate the study hypothesis.

Assessing the effectiveness of EMG-biofeedback on an isometric strengthening program in individuals with multiple sclerosis

The purpose of this randomized controlled experiment was to assess the efficacy of electromyographic biofeedback as an adjunct treatment to isometric exercise in MS patients. 20 patients took part in the research. Patients were randomly assigned to one of two groups: biofeedback (n = 10) or control (n = 10). Over a period of six weeks, participants followed their individual workout plans five days a week. The control group just received an exercise program, whereas the biofeedback group received an electromyographic biofeedback-guided isometric exercise program. The study's endpoints included quadriceps strength, functional impairment, and pain. At baseline, Week 2, Week 4, Week 6, and at a follow-up at Week 12, measurements were obtained. In between-group comparisons, the pain intensity, maximal isometric quadriceps strength and functional disability in the biofeedback group was substantially larger than that of the control group at the end of the sixth week (p< 0.05). For MS patients with quadriceps muscle problems, adding electromyographic biofeedback (EMG-BF) to a 6-week isometric exercise program showed to boost quadriceps muscle strength more than the exercise program alone. The findings, however, should be taken with care owing to research design constraints.

Autoantibody-Based Clinicoradiopathologic Phenotyping of Idiopathic Inflammatory Myopathies: An Indian Cohort.

We aim to characterize the clinical, pathological, laboratory and imaging features of various antibody defined IIM subgroups in Indian population. 103 patients who satisfied 2017 ACR/ EULAR Classification criteria for IIM, and tested seropositive for myositis antibodies using Immunoblot technique were retrospectively identified. Patients were classified into following subgroups - Mi2B group, SRP group, Anti RNA Synthetase antibody group (Jo 1, PL 7, PL 12, OJ), multiple MSA, only MAA group (U1RNP, Ro 52, SS-A, SS-B, PM Scl 75, PM Scl 100). Clinical, laboratory, histopathology and imaging parameters were compared among different groups. Ro52 (n = 31; 22.46%) was the most common autoantibody seen in our cohort followed by Mi2B (n = 26; 18.84%) and SRP (n = 20; 14.49%). Skin manifestations (p = 0.053) and joint involvement (p = 0.023) were seen more frequently among Mi2B and MAA sub groups. Three out of 4 patients with persisting antibody positivity on serial measurements developed clinical relapse between 2 and 3 years after the initial episode. Remaining 2 patients showed declining titres of antibodies and developed no clinical relapses during follow up period of 5 and 6 years. Among histopathology features, perifascicular atrophy was found to be more prevalent among Mi2B (55.6%) and MAA subgroups (31.3%) (p value = 0.037). In thigh muscle MRI, Mi2B group showed a pattern of diffuse involvement of affected muscles without regional preference, with sparing of hamstring group. SRP group showed characteristic pattern of edema involving peripheral regions of Quadriceps femoris and central regions of Adductor group along with severe atrophy involving hamstring and adductor compartment muscles. ILD was seen in 27.5% of patients who underwent CT Chest. 3 patients were found to have underlying malignancy at the time of diagnosis of myositis (Mi2B = 2 and PM Scl = 1). Classification of IIM patients based on myositis antibodies yields subgroups with certain differences in clinical, laboratory, histopathological and imaging features.

Efficacy of Blood Flow Restriction Exercise for Improving Lower Limb Muscle Strength and Function in Chronic Spinal Cord Injury: A Randomized Controlled Trial.

The objective of the present study was to evaluate the efficacy of low-load (LL) blood flow restriction exercise (BFRE) for improving lower limb muscle strength, muscle thickness and physical function in individuals with spinal cord injury (SCI). In a randomized sham-controlled trial, 21 participants (age ≥ 18 years, SCI duration ≥ 1 year, knee extensor strength grade 2-4, ASIA A-D) were randomized to either 45-min LL-BFRE (n = 11) or sham BFRE (n = 10) twice/week for 8 weeks. The exercise protocol consisted of four sets (30 × 15 × 15 × 15 repetitions) of unilateral seated leg extensions and leg curls at 30%-40% of 1RM performed with pneumatic cuffs applied proximally on the trained limb and inflated to 40% of total arterial occlusion pressure (BFRE) or non-inflated (sham exercise). Maximal voluntary isometric quadriceps and hamstring muscle strength, quadriceps muscle thickness, thigh circumference, and physical function were assessed at baseline, after 4 and 8 weeks of training and at 4-week follow-up. No significant between-group differences were found between BFRE and sham exercise in quadriceps or hamstring muscle strength, 10-m walking test, timed up & go, 6-min walking test or the spinal cord independence measure. In contrast, a significant between-group difference favoring BFRE was present for muscle thickness and thigh circumference from baseline to 4-week follow-up (0.76 cm (95% CI: 0.32; 1.20, p = 0.002) and 2.42 cm (0.05; 4.79, p = 0.05), respectively). In conclusion, there was no significant difference in the effect of LL-BFRE and sham exercise on muscle strength and physical function in individuals with SCI. However, significant increases in muscle thickness and thigh circumference were observed in favor of BFRE. Trial Registration: ClinicalTrials.gov identifier: NCT03690700.

Association between muscle strength and echogenicity using greyscale ultrasound software: a diagnostic accuracy study in kidney transplant candidates.

Advanced chronic kidney disease disrupts the delicate equilibrium between protein anabolism and catabolism, leading to alterations in muscle quantity, quality, and function. Musculoskeletal ultrasound emerges as a promising assessment tool due to its widespread availability and high reliability. To evaluate the efficacy of rectus femoris (RF) echogenicity, measured using greyscale software, in identifying diminished muscle quality and strength in candidates for kidney transplant. Post-hoc diagnostic accuracy study. Outpatients in a multimodal prehabilitation program pre kidney transplantation (KT). Patients on the waiting list for KT. Sensitivity, specificity, likelihood ratios and area under the curve (AUC) for diagnostic efficacy of echogenicity (index test) assessed with the ImageJ software greyscale as a potential marker of quadriceps muscle weakness (reference test) were calculated. Muscle weakness was considered as maximal voluntary isometric contraction of the quadriceps (Q-MVIC) <40% of body weight. Other variables included body composition parameters derived from multifrequency electrical bioimpedance, upper limb muscle strength (handgrip), and RF thickness assessed by ultrasound. Chi-square, t-Student, Pearson correlation coefficients (r), bivariate and multivariate logistic regression models. Statistical significance level ≤0.05. Of 112 patients (mean age: 63.6, 76% male), 72 (63.7%) exhibited quadriceps weakness, while 80 (70.8%) had some degree of overhydration (extracellular water/total body water ratio >0.390). The echogenicity cut-off point of highest concordance with muscle weakness was 70, boasting a sensitivity of 83%, specificity of 57%, and AUC of 0.671 (CI 95% 0.570-0.772 [P=0.003]). Echogenicity >70 was associated with a 3.4-fold higher risk of muscle weakness (crude OR = 3.4 [CI95% 1.4 to 8.0]), which persisted after adjusting for age, height, weight and RF thickness. The RF echogenicity exhibits fair validity in identifying muscle weakness among candidates for KT. However, it cannot be endorsed as a standalone diagnostic tool in this population. Early identification of muscle weakness would advance efforts to mitigate morbidity and mortality through targeted measures.

Comparison of Analgesic Efficacy between Ultrasound-guided Supra-inguinal Fascia Iliaca Block and Pericapsular Nerve Group Block following Total Hip Arthroplasty: A Randomized Controlled Trial.

The effectiveness of pericapsular nerve group (PENG) block versus suprainguinal fascia iliaca block (SFIB) for pain relief after hip arthroplasty is a topic of ongoing debate. This study aimed to examine the association of PENG block with lower consumption of opioids during the first 24 hours following surgery compared to SFIB. In this single-center, double-blind, randomized controlled trial, 60 patients scheduled for an elective posterior approach to total hip arthroplasty (THA) were randomized according to two groups: ultrasound-guided PENG block (PENG group) or SFIB (SFIB group). The 24-hour consumption of intravenous fentanyl was the primary outcome. Secondary outcomes included perioperative consumption of intravenous fentanyl, pain scores, sensorimotor function, and functional measures. No significant intergroup difference was observed in 24-hour total fentanyl consumption (SFIB group: 117.4±99.8 μg, PENG group: 145.9±122.7 μg; mean difference: 22.6 μg [95% confidence interval -36.6 to 81.8]; P=0.45). No statistically significant difference in terms of fentanyl consumption in intraoperative, post-anesthetic care unit, at 6-hour and 48-hour postoperatively was observed between the two groups. No statistically significant differences in scores for rest and dynamic pain for all aspects of hip joint and surgical incision were observed between the groups (P>0.05). Better cutaneous sensory perception in the hip region and 12-hour postoperative quadriceps muscle strength at 90° were observed in the PENG group compared with the SFIB group (P<0.05). Compared to SFIB, the addition of PENG block to multimodal analgesia did not reduce fentanyl consumption or pain scores after posterior approach THA.

Oh, My Quad: A Clinical Commentary And Evidence-Based Framework for the Rehabilitation of Quadriceps Size and Strength after Anterior Cruciate Ligament Reconstruction.

Quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) is a well-known phenomenon, with more persistent quadriceps weakness observed after ACLR with a bone-patellar tendon-bone or quadriceps tendon autograft than with a hamstring tendon autograft. Longstanding quadriceps weakness after ACLR has been associated with suboptimal postoperative outcomes and the progression of radiographic knee osteoarthritis, making the recovery of quadriceps size and strength a key component of ACLR rehabilitation. However, few articles have been written for the specific purpose of optimizing quadriceps size and strength after ACLR. Therefore, the purpose of this review article is to integrate the existing quadriceps muscle basic science and strength training literature into a best-evidence synthesis of exercise methodologies for restoring quadriceps size and strength after ACLR, as well as outline an evidence-informed quadriceps load-progression for recovering the knee's capacity to manage the force-profiles associated with high-demand physical activity. Level of Evidence: 5.

Joint Effusion at 3 Months After Anterior Cruciate Ligament Reconstruction: Its Risk Factors and Association With Subsequent Muscle Strength and Graft Remodeling.

Joint effusion at 3 months after anterior cruciate ligament (ACL) reconstruction is a risk factor for ACL reinjury. However, factors associated with joint effusion at 3 months postoperatively and the effect of joint effusion on subsequent quadriceps muscle strength and graft remodeling remain unknown. To identify factors associated with joint effusion and investigate the association between joint effusion and quadriceps muscle strength and graft remodeling in the postoperative period. Case-control study; Level of evidence, 3. In this retrospective multicenter study, the medical records of patients who underwent single-bundle ACL reconstruction between 2015 and 2021 were reviewed. The study included the data of 174 patients (mean age, 23.5 ± 10.6 years). Demographic data, including sex, age at surgery, time from injury to surgery in months, body mass index, preinjury Tegner activity score, presence of meniscus, and chondral injuries, were collected. Magnetic resonance imaging was performed 3 months postoperatively. Joint effusion was defined as grade 3 (range of grades, 0-3) according to the ACL Osteoarthritis Score. Isokinetic strength testing was performed at 60 deg/s, while the limb symmetry index (LSI) of quadriceps strength was evaluated at 6 months postoperatively. Moreover, graft remodeling was evaluated using magnetic resonance imaging-derived signal intensity ratio (SIR) measures at 1 year postoperatively. The authors used multivariate logistic and linear regression analyses to identify the factors influencing joint effusion at 3 months and those associated with postoperative quadriceps strength LSI and SIR values, respectively. Greater preinjury Tegner activity scores (odds ratio, 1.59; 95% CI, 1.08 to 2.34; P = .02) increased the odds of joint effusion at 3 months postoperatively. Multivariable linear regression analysis revealed that joint effusion (β = -23.8; 95% CI, -36.0 to -11.7; P < .001) was an independent factor associated with LSI of the quadriceps. Furthermore, joint effusion (β = 1.33; 95% CI, 0.53 to 2.14; P = .001) was associated with a higher SIR value of the reconstructed graft. The preinjury Tegner activity score was a factor associated with joint effusion at 3 months postoperatively, and joint effusion was associated with subsequent muscle weakness and delayed graft remodeling.

Is it truly impossible to strengthen the vastus medialis in isolation from the entire quadriceps muscle group?

Is it truly impossible to strengthen the vastus medialis in isolation from the entire quadriceps muscle group?

Clinical Implications Of Functional Imaging In The Assessment Of Bronchiectasis-Associated Sarcopenia

Bronchiectasis is a complex lung disease with poorly studied systemic manifestations. Patients with bronchiectasis-associated sarcopenia exhibit a specific differential profile of functional muscle phenotype (vastus lateralis, VL), which may be analyzed using imaging (ultrasound and magnetic resonance imaging, MRI). Ultrasound and MRI were used to explore functional imaging parameters in quadriceps of 20 patients with stable bronchiectasis and 10 healthy controls. In muscle specimens (open biopsy procedures), muscle phenotype (fiber morphometry and structural abnormalities, immunohistochemistry) was also evaluated. Patients and controls were clinically and functionally evaluated. In muscles of patients compared to controls, a significant decline in body composition parameters (BMI and FFMI), muscle function (upper and lower limbs), lung function, and exercise capacity was detected, ultrasonography revealed decreased muscle thickness and area, while MRI demonstrated increased fat infiltration, which positively correlated with the bronchiectasis severity scores. Structural parameters (proportions of hybrid fibers, internal nuclei, abnormal fibers, and apoptotic nuclei) were significantly greater in the VL of patients than in controls and inversely correlated with quadriceps muscle function and exercise capacity in the former. In patients with stable mild-to-moderate bronchiectasis, sarcopenia was clinically evidenced through the significant reduction in muscle mass and upper and lower limb muscle function. Non-invasive ultrasound and MRI techniques showed that features of muscle quality architecture and fat infiltration are hallmarks of bronchiectasis-associated sarcopenia. Functional radiological tools should be implemented in clinical settings to early diagnose and monitor sarcopenia in these patients.

Reconstruction de l’aponévrose musculaire de la zone donneuse du lambeau antérolatéral de cuisse par plaque synthétique : technique et bénéfice

The anterolateral thigh flap is sometimes harvested with a portion of the quadriceps muscle fascia, which can lead to muscle hernias or adhesions at the donor site. Studies report an 11 to 32% incidence of muscle hernias and an 8 to 26% incidence of persistent weakness at the donor site. There is no data in the scientific literature presenting a surgical technique for the prevention of muscle hernias at the donor site of the anterolateral thigh flap. The objective of our study is to describe our technique for placing a synthetic mesh when closure of the fascia is not possible during the harvesting of an anterolateral thigh flap, in order to reduce the risk of postoperative muscle hernias and to analyze its benefits. As part of a prospective study, we present here our technique for reconstructing the fascia by placing a non-resorbable synthetic mesh. Twenty-two patients underwent the placement of a mesh for the reconstruction of the fascial defect, which averaged 9.6cm. One year after the procedure, none of the patients presented with a muscle hernia or adhesions at the donor site. According to studies, muscle hernias and scar adhesions occur in 11 to 32% of cases and are both unsightly and disabling for patients. Although it is difficult to quantify the benefit in terms of muscle strength, fascia reconstruction effectively prevents this type of complication. When the defect is greater than 8cm, we believe it is essential to reconstruct the fascia during harvesting to prevent the occurrence of hernia or adhesion at the donor site. While not affecting limb function, muscle hernia is at least aesthetically bothersome and should be systematically prevented. Reconstruction of the muscle fascia at the donor site of the anterolateral thigh flap with a non-resorbable synthetic mesh, in cases of a defect greater than 8cm, prevents the occurrence of muscle hernias and adhesions, which can lead to aesthetic and functional complications.