Quadriceps Research Articles

Quantifying Muscle Volume Deficits Among 38 Lower Extremity Muscles in Collegiate Football Athletes After Anterior Cruciate Ligament Reconstruction.

Quadriceps dysfunction is ubiquitous after anterior cruciate ligament (ACL) reconstruction (ACLR). Addressing quadriceps dysfunction is crucial to improve function, reduce the reinjury risk, and maintain long-term knee health. While deficits specific to the quadriceps are well documented, less is known about the effect of an ACL injury on other lower extremity muscle groups. The purpose of this exploratory analysis was to quantify and rank lower extremity muscle volume deficits using magnetic resonance imaging in collegiate football athletes after ACLR. It was hypothesized that the quadriceps muscles would present with the greatest deficits and that compensatory hypertrophy of muscles at adjacent joints such as the hip and ankle would be observed. Cross-sectional study; Level of evidence, 3. This study is a secondary analysis from an ongoing multicenter prospective cohort study involving Division I collegiate football athletes. Athletes who underwent primary unilateral ACLR (1 [3%] allograft, 2 [7%] quadriceps tendon autograft, 22 [73%] bone-patellar tendon-bone autograft, 5 [17%] hamstring tendon autograft) and magnetic resonance imaging were included. Muscle volumes (mL·kg-1·m-1) were quantified bilaterally from 38 lower extremity muscles using machine learning technology. Paired-samples t tests were performed between limbs for each muscle, which were then ranked and visualized in a forest plot based on standardized mean differences (surgical - nonsurgical limb). A total of 30 athletes (mean time from surgery, 27.9 ± 19.0 months) were included. The largest muscle volume deficits in the surgical limb were seen in the 3 uniarticular quadriceps muscles, followed by the biarticular triceps surae muscles. The rectus femoris and soleus did not show significant differences between limbs. Conversely, the fibularis muscle group had a greater muscle volume in the surgical limb compared with the nonsurgical limb. Most other muscle groups did not present significant differences between limbs. Persistent quadriceps atrophy in a cohort of high-level athletes over 2 years after ACLR was highlighted in this study. Deficits in the gastrocnemius muscles, but not in the soleus, were also identified. This comprehensive approach examining various lower extremity muscles revealed latent muscle volume deficits present after ACLR.

Extracorporeal shockwave therapy rescued mouse critical limb ischemia via upregulating GPR120 against inflammation and promoting angiogenesis for restoring the blood flow in ischemic zone-experimental study.

This study tested the hypothesis that extracorporeal shockwave therapy (ECSWT) effectively rescues critical limb ischemia (CLI) in mice through the upregulation of GPR120, which protects against inflammation and angiogenesis to restore blood flow in the ischemic area. Compared with the control, ECSWT-induced GPR120-mediated anti-inflammatory effects significantly suppressed the expression of inflammatory signaling biomarkers (TAK1/MAPK family/NF-κB/IL-1β/IL-6/TNF-α/MCP-1) in HUVECs, and these effects were abolished by silencing GPR120 or by the GPR120 antagonist AH7614 (all P < 0.001). C57BL/6 mice (n =40) were equally categorized into Groups 1 (sham-operated control), 2 (CLI), 3 (CLI+ECSWT), and 4 (CLI+ECSWT+AH7614). By Days 7, 14, and 28 just prior to harvesting the quadriceps muscle, the laser Doppler results showed that the ratio of ischemia to normal blood flow (INBF) in the CLI area was highest in Group 1, lowest in Group 2, and significantly greater in Group 3 than in Group 4 (all P < 0.0001). Endothelial cell markers (CD31/vWF) and GPR120+cells exhibited identical patterns of INBF among the groups, whereas angiogenesis biomarkers (CXCR4/SDF-1/VEGF/VEGFR2) were significantly and progressively upregulated from Groups 1 to 4 (all P < 0.0001). The protein levels of inflammation (MMP-9, IL-6, and TNF-α) and oxidative stress (NOX-1 and NOX-2) and the cellular levels of inflammation (CD68+)/DNA damage (γ-H2AX+) displayed opposite patterns, whereas the small vessel density in the CLI area displayed an identical pattern of INBF among the groups (all P < 0.0001). ECSWT rescued CLI by increasing GPR120-mediated suppression of inflammation and enhancing angiogenesis via activation of VEGFR2.

Nutritional Interventions to Attenuate Quadriceps Muscle Deficits following Anterior Cruciate Ligament Injury and Reconstruction.

Following anterior cruciate ligament (ACL) injury, quadriceps muscle atrophy persists despite rehabilitation, leading to loss of lower limb strength, osteoarthritis, poor knee joint health and reduced quality of life. However, the molecular mechanisms responsible for these deficits in hypertrophic adaptations within the quadriceps muscle following ACL injury and reconstruction are poorly understood. While resistance exercise training stimulates skeletal muscle hypertrophy, attenuation of these hypertrophic pathways can hinder rehabilitation following ACL injury and reconstruction, and ultimately lead to skeletal muscle atrophy that persists beyond ACL reconstruction, similar to disuse atrophy. Numerous studies have documented beneficial roles of nutritional support, including nutritional supplementation, in maintaining and/or increasing muscle mass. There are three main mechanisms by which nutritional supplementation may attenuate muscle atrophy and promote hypertrophy: (1) by directly affecting muscle protein synthetic machinery; (2) indirectly increasing an individual's ability to work harder; and/or (3) directly affecting satellite cell proliferation and differentiation. We propose that nutritional support may enhance rehabilitative responses to exercise training and positively impact molecular machinery underlying muscle hypertrophy. As one of the fastest growing knee injuries worldwide, a better understanding of the potential mechanisms involved in quadriceps muscle deficits following ACL injury and reconstruction, and potential benefits of nutritional support, are required to help restore quadriceps muscle mass and/or strength. This review discusses our current understanding of the molecular mechanisms involved in muscle hypertrophy and disuse atrophy, and how nutritional supplements may leverage these pathways to maximise recovery from ACL injury and reconstruction.

Association Between Quadriceps Muscle Strength and the Forgotten Joint Score After Total Hip Arthroplasty.

Total hip arthroplasty (THA) effectively enhances hip function and alleviates pain in patients who have osteoarthritis, improving their quality of life. The Forgotten Joint Score-12 (FJS-12), a patient-reported outcome measure, has recently gained attention as a method for assessing joint awareness during daily activities following THA; however, the association between muscle strength, specifically quadriceps muscle strength, and the FJS-12 has not been fully investigated. This cross-sectional study involved 624 patients who underwent THA at a single center in Japan. The mean patient age was 67 (range, 43 to 94) years, and 85.3% of the cohort were women. We aimed to investigate the association between quadriceps muscle strength and the FJS-12 (measured at 12 months postoperatively) using multiple regression analyses adjusted for variables such as pain and leg length discrepancy. The mean FJS-12 was 72.2, and the mean quadriceps muscle strength was 1.2 Nm/kg. Higher quadriceps muscle strength was significantly associated with better FJS-12 outcomes (β = 0.28, P < 0.001). Conversely, increased pain and perceived leg length discrepancy were negatively associated with lower FJS-12 values. Our findings indicate that quadriceps muscle strength is a crucial determinant of joint awareness as measured using the FJS-12 in patients undergoing THA. These results highlight the potential benefits of targeted rehabilitation to enhance quadriceps muscle strength, which may help patients undergoing THA experience less joint awareness in their daily activities.

Degeneration of the cartilage quality is correlated with a higher intramuscular fat infiltration of the vastus medialis in older adults with pre-to-mild knee osteoarthritis.

To quantitatively verify whether degeneration in the quality of the medial femoral cartilage is correlated with muscle volume loss and intramuscular adipose tissue (IntraMAT) infiltration in quadriceps using magnetic resonance imaging (MRI). Of the 66 older adult participants ≥60years old (74.5±6.9 years), 29 were female. All participants were patients with pre-to-mild knee osteoarthritis. Muscle volume and IntraMAT infiltration of the four individual muscles, the rectus femoris (RF), vastus medialis (VM), vastus intermedius, and vastus lateralis were assessed, using proton density-weighted and 2-point Dixon MR images. Based on the MRI T2 mapping, the T2 relaxation times of the weight-bearing surface of the medial femoral cartilage were calculated. Simple linear regression analyses were performed, evaluating the correlations between the T2 relaxation time of the medial femoral cartilage and quadriceps muscle volume and IntraMAT. Multiple linear regression analysis using a stepwise method was performed, determining which indicators of the four individual muscles correlated with cartilage quality degeneration. Simple linear regression analyses revealed that a longer T2 relaxation time of the medial femoral cartilage was positively correlated with IntraMAT infiltration of the entire quadriceps muscle, RF, and VM, however not with the quadriceps muscle volume. Multiple linear regression analysis revealed that VM IntraMAT was particularly correlated with the extension of T2 relaxation time of the medial femoral cartilage. In older adults with pre-to-mild knee osteoarthritis, IntraMAT infiltration of the quadriceps muscles, particularly of the VM was correlated with degeneration in the quality of the medial femoral cartilage.

Alterations in whole muscle quality and physiological cross-sectional area measured with quantitative MRI following ACL injury

BackgroundEmerging evidence suggests that there are morphological and physiological changes to the vastus lateralis after an anterior cruciate ligament (ACL) tear. However, it is unclear whether these alterations are limited to just the vastus lateralis or are more representative of widespread changes across the thigh musculature and/or if these changes precede reconstruction. The purpose of this study was to determine T1ρ relaxation time, a measure of extracellular matrix organization in muscle, and physiological cross-sectional area (PCSA) for muscles of the quadriceps and hamstrings of the ACL-deficient and contralateral limbs soon after ACL injury.MethodsT1ρ and diffusion tensor magnetic resonance imaging were performed on both limbs of 10 participants after primary ACL tear (< 10 weeks). T1ρ relaxation time and PCSA were calculated for all muscles of the quadriceps and hamstrings. Shapiro-Wilks tests were performed to assess normality. Outcomes were compared between limbs for each muscle of interest with paired t-tests or Wilcoxon signed-rank tests with the alpha level set to 0.05.ResultsT1ρ relaxation times were significantly longer for the vastus lateralis (7.0%), rectus femoris (15.4%), and vastus intermedius (9.4%) of ACL-deficient limb; whereas, relaxation times were similar between limbs for all hamstring muscles. PCSA was smaller for the vastus lateralis (-19.6%), vastus intermedius (-20.9%), vastus medialis (-26.0%), and semitendinosus (-15.0%) of the ACL-deficient limb compared to the contralateral limb.ConclusionsThese results provide evidence that morphological and physiological alterations occur within multiple muscles of quadriceps but not the hamstrings prior to ACL reconstruction. Establishing these differences between the quadriceps and hamstrings suggests there is a differential response within the thigh musculature to an ACL injury, providing a framework for more targeted interventions.

Sonographic and Anthropometric Measurements for Body Composition and Their Relationship with Functioning in Adolescent Obesity.

Obesity is one of the most common chronic diseases seen in children and adolescents. This study aims to examine the impact of obesity on body composition, assessed by sonographic and anthropometric measurements, and health-related quality of life (HRQoL) in adolescents.Anthropometric measurements, sonographic measurements of subcutaneous fat, quadriceps muscle, Achilles tendon thickness, and HRQoL were performed in children between 12-18 years of age. Comparisons between adolescents with obesity and normal body mass index (BMI) were examined.A total of 300 adolescents with similar physical activity levels, 28.7% with obesity, were enrolled. The thickness of mid-forearm/mid-thigh subcutaneous fat tissue and quadriceps muscle was significantly higher in participants with obesity (p≤0.001). Moderate-to-strong correlation with BMI and waist circumference was observed (r>0.40, p<0.01). Participants with longer duration of obesity had thicker quadriceps muscle irrespective of the severity of obesity or presence of metabolic syndrome. Achilles tendon thickness did not differ between the groups. HRQoL was significantly lower in adolescents with obesity and indicated a negative moderate correlation between physical functioning and subcutaneous fat thickness (r<- 0.50, p<0.01).An important relationship between sonographic and anthropometric measurements, and physical functioning was demonstrated in adolescents. Ultrasound seems to have a role in the evaluation of body composition in obesity beyond what is captured by overall BMI. Significantly increased quadriceps muscle thickness in adolescents with obesity, coupled with its relation to the duration of obesity, implies potential temporal association between excess body weight and adaptation of quadriceps muscle.

Stable Gastric Pentadecapeptide BPC 157 as Therapy After Surgical Detachment of the Quadriceps Muscle from Its Attachments for Muscle-to-Bone Reattachment in Rats.

This is a novel rat study using native peptide therapy, focused on reversing quadriceps muscle-to-bone detachment to reattachment and stable gastric pentadecapeptide BPC 157 per-oral therapy for shared muscle healing and function restoration. Pharmacotherapy recovering various muscle, tendon, ligament, and bone lesions, and severed junctions (i.e., myotendinous junction), per-oral in particular (BPC 157/kg/day 10 µg, 10 ng), provides muscle-to-bone reattachment after quadriceps muscle detachment, both complete (rectus muscle) and partial (vastus muscles). Immediately post-injury, and at 1, 2, 3, 5, 7, 14, 21, 28, 60, and 90 days post-injury, quadriceps muscle-to-bone detachment showed definitive healing failure (impaired walking and permanent knee flexure). Contrarily, macro/microscopic, ultrasonic, magnetic resonance, biomechanical, and functional assessments revealed that BPC 157 therapy recovering effects for all time points were consistent. All parameters of the walking pattern fully improved, and soon after detachment and therapy application, muscle approached the bone, leaving a minimal gap (on ultrasonic assessment), and leg contracture was annihilated. The healing process occurs immediately after detachment from both sides: the muscle and the bone. The reattachment fibers from the ends of the muscle could be traced into the new bone formed at the surface (note, at day 3 post-detachment, increased mesenchymal cells occurred with periosteum reactivation). Consequently, at 3 months, the form was stable, and the balance between the muscle and bone was the following: well-organized bone, newly formed as more cortical bone providing a narrower bone marrow space, and the muscle and mature fibers were oriented parallel to the bone axis and were in close contact with bone. Therefore, to achieve quadriceps muscle-to-bone reattachment, the BPC 157 therapy reversing course acts from the beginning, resolving an otherwise insurmountable deleterious course.

Clinical SANTI classification of arthrogenic muscle inhibition has an excellent inter-rater and intra-rater reliability in preoperative and post-operative anterior cruciate ligament rupture.

Arthrogenic muscle inhibition (AMI) is a reflexive shutdown of the quadriceps muscles following a knee injury or surgery that presents with or without hamstring contracture. This complication can be classified according to the SANTI classification, but the reproducibility of this clinical classification has not yet been demonstrated. This single-centre longitudinal observational study included 140 patients who were within 6 weeks of an ACL rupture. The presence of AMI was assessed separately and blindly during the preoperative consultation and at 3 weeks post-operative by an Orthopaedic Surgeon, an Orthopaedic Resident, a Sports Medicine Physician and a Physiotherapist. AMI was also assessed a second time by the physiotherapist, 10 days after the first assessment, before and after reconstruction surgery, in order to measure intra-rater reliability. The inter-rater and intra-rater reliability of the AMI classification was determined by calculating the intraclass correlation coefficient (ICC). Agreement for the AMI classification between different examiners was excellent pre-operatively (ICC = 0.99 [95% confidence interval, CI: 0.99-0.99]) and post-operatively (ICC = 0.98 [95% CI: 0.98-0.99]). Agreement in the AMI classification, when determined repeatedly by the same assessor (physiotherapist), was excellent pre-operatively (ICC = 0.92 [95% CI: 0.89-0.94]) and post-operatively (ICC = 0.98 [95% CI: 0.97-0.99]). Excellent intra-rater and inter-rater reliability of the AMI classification system was found in patients with recent ACL rupture and post-operatively. Level II, diagnostic study prospective cohort study.

Prevalence and location of myofascial trigger points in dogs with osteoarthritis

IntroductionThis study was designed to determine the prevalence of myofascial pain and the location of myofascial trigger points (MTPs) in dogs with osteoarthritis.MethodsThirty-five dogs were selected and examined for the presence of MTPs using palpation. Assessments were performed independently by two examiners. Correlations between age, MTP number and location, and the site of osteoarthritis were also investigated.Results and discussionThirty out of 35 dogs (86%) had at least one MTP and only 5 (14%) had none. A total of 177 MTPs were identified in dogs in this sample. The prevalence of MTPs was higher in the longissimus thoracicae (40% and 43%; left and right side respectively), followed by the quadriceps femoris (40% and 31%), longissimus lumborum (20% and 23%), gluteus medius and deltoid muscles (14%; left side only), and the pectineus muscle (11%; right side only). The number of osteoarthritic joints was not correlated with the number of MTPs or age. However, age was positively correlated with the number of muscles affected by MTPs. Correlations between the presence of MTPs in muscles surrounding and the affected joints were also lacking.ConclusionThe prevalence of MTPs in dogs with osteoarthritis is high. Myofascial TPs are positively correlated with age in these patients. The subjective nature of palpation is a major limitation in myofascial pain assessment. Appropriate training and use of standardized diagnostic criteria are recommended.

Therapeutic effect of proprioceptive dolphin assisted activities on health-related quality of life and muscle tension, biomechanical and viscoelastic properties in major depressive disorder adults: case analysis.

The case analysis method is widely used in evaluating dolphin assisted activities due to the lack of research participants. Despite other present diagnostic features adults with major depressive disorder experience psychomotor changes, dysphoria, anhedonia, impaired concentration, and suicidal thoughts. Increasing studies assess the positive effect of proprioceptive exercises in various depressive cases. 14 adults diagnosed major depressive disorder included in this case study between September 2022 to April 2024. A two-week proprioceptive dolphin assisted activity program was applied for each with a two-day break after half applied activities, in total 10 activities for each were organised. Proprioceptive dolphin assisted activities varied from heavy muscle work to muscles and joints pressure which was held in a special therapeutic pool, where adults wore wetsuits. The SF-36 scale was used, with levels of QoL compared among: (a) before dolphin assisted activities, (b) after two-week proprioceptive dolphin assisted activities, (c) in a year after two-week proprioceptive dolphin assisted activities. The MyotonPro portable device was used for measuring muscle tension, biomechanical and viscoelastic properties each day of participation: (a) before dolphin assisted activities and (b) after dolphin assisted activities. The MyotonPro was applied to measure the upper (descending) part of the trapezius muscle, lateral part of the deltoids muscle, middle point of the flexor carpi radialis muscle, middle point of the long head of the biceps brachii muscle, the gastrocnemius muscle (plural gastrocnemii), and quadriceps femoris muscle. The measuring results of SF-36 scale showed statistically significant changes in 5 subscales out of 8 (Friedman's test p-value less than 0.05) and in one more scale a partially significant change (p < 0.1). The physical activity that increased after dolphin therapy (from 68.5 to 85) remained the same in one year. There were no statistically significant changes in role limitations due to physical health. However, role limitations due to emotional problems and partially significant changes were recorded, the situation slightly worsened a year later, but there was no statistically significant deterioration. The non-parametric Wilcoxon test was used to compare two dependent samples measured by the MyotonPro. Although the improvement was recorded in almost all muscle groups, statistically significant changes were observed only in trapezius muscle md p right, measuring stiffness, relaxation and creep; trapezius md p left measuring frequency, stiffness, relaxation and decrement; and deltoids muscle left, measuring frequency, stiffness and relaxation, i.e., the p-values of Wilcoxon test are less than 0.05. Two-weeks of proprioceptive dolphin assisted activities for adults with major depression have statistically significant long-term change in better physical parameters. Emotional betterment parameters were less stable. The quick reactivity of trapezius muscle revealed that dolphin assisted activities acts as stress relief, and deltoids muscle as relief of negative emotions, such as fear and anger.

Therapeutic Neuroscience Education In Fibromyalgia: A Randomized Controlled Trial

Abstract To investigate additive effect of Therapeutic Neuroscience Education (TNE) to pilates exercises in female patients with fibromyalgia (FM).25 female patients FM included in the study. They randomly separated into two groups. There were 11 patients in the intervention group and 14 patients in the control group. Pilates exercises and TNE were applied in the intervention group, and only pilates exercises were applied in the control group. Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA), Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), Widespread Pain Index (WPI), Fibromyalgia Impact Questionnare (FIQ), Symptom Severity Scale (SSS), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Biopsychosocial Questionnaire (BETY-BQ) and pressure algometer was used for evaluation.After the treatment, control group improved in the “visuomotor construction” and “thinking operations"cognitive areas andtotal score of DLOTCA, BPI-pain severity score, VAS, FIQ, SSS, PCS-magnification, and only left medial knee mean score of pressure pain thresholds (p&lt;0.05). Intervention group improved in the “thinking operations” cognitive area and total score of DLOTCA, BPI-pain severity score, BPI-pain interference score, VAS, WPI, FIQ, SSS, TSK, BETY-BQ and all pressure pain thresholds (excluding left trapezius) (p&lt;0.05). In the comparison of delta values, the intervention group improved more in WPI, FIQ, right trapezius mean score and left trapezius, right quadriceps femoris, right-left medial knee maximum and mean scores of pressure pain thresholds (p&lt;0.05). TNE increased the effectiveness of pilates exercises on pain, functional status and pressure pain thresholds in patients with FM.

The Effect of Resistance Strength Training on Muscle Cross Education: A Meta analysis

Introduction: At present, a large number of studies have found that the phenomenon of cross transfer has achieved significant research results in sports training, rehabilitation therapy, and influencing mechanisms. Cross training refers to increasing muscle strength on the training side, while there is also a significant increase in muscle strength on the untrained homologous side. The main purpose of this review is to explore the impact mechanism of cross transfer phenomenon and summarize the optimal training methods and rehabilitation methods for cross transfer phenomenon. Aim of the study: Using meta-analysis method to systematically evaluate the effects of cross training (also known as cross education) on upper and lower limb muscle strength in different age groups and compare the training results. Material and methods: The system searched databases such as Wanfang Digital Resource Database, China National Knowledge Infrastructure Database, EBSCOhost, PubMed, Web of Science, and Cochrane Library from the default start time to December 2024. Two evaluators independently screened research literature on resistance strength training improving upper and lower limb muscle strength and hypertrophy in various age groups based on inclusion and exclusion criteria. Revmen 5.3 was used to evaluate all included literature and analyze their data. Result: 1)After 4 rounds of exclusion, 7 articles were finally included with a total sample size of 257 people; 2) Cross education intervention under resistance strength training can significantly enhance the strength of the quadriceps muscle in adults, with better results than the control group. The combined effect size is SMD=8.03, 95% CI:- 1.32，17.37， P＜0.01， 3) The degree to which cross education intervention enhances the strength of the gastrocnemius and wrist extensor muscles under resistance strength training is similar. The combined effect quantities are: SMD＝0.17，95% CI：-2.28，2.62，P≥0.01； SMD＝-0.39，95% CI：-3.02，2.25，P≥0.01； SMD=0.20, 95% CI: -0.81, 1.21, P ≥ 0.01 Conclusion: Cross education intervention under resistance strength training can significantly improve quadriceps strength and promote muscle hypertrophy in adults; The effect of cross education intervention under resistance force on promoting the strength and hypertrophy of the gastrocnemius muscle and wrist extensor muscle is similar.

Association of Physical Function, Quantity, and Quality of the Quadriceps with Postoperative Physical Activity Before Total Knee Arthroplasty.

Background/Objectives: This single-center cohort study investigated preoperative risk factors such as physical function, quantity, and quality of the quadriceps femoris for physical activity (PA) 1 year after total knee arthroplasty (TKA). Methods: This study included 204 patients with knee osteoarthritis who underwent TKA; they were divided into increased and decreased PA groups. Items with significant differences between the two groups in non-operative-side quadriceps strength, knee injury and osteoarthritis outcome scores (KOOS), Sport/Rec scores, operative-side cross-sectional area (CSA) of the vastus medialis (VM), and operative-side computed tomography attenuation values (CTV) of the vastus lateralis (VL) were fitted in the multiple logistic regression analysis. The cutoff value of the preoperative CSA of the VM required for PA to exceed the required points at 1 year postoperatively was calculated using the receiver operating characteristic (ROC) curve. Results: Multivariate logistic regression analysis showed that the non-operative-side quadriceps strength KOOS sport/rec, operative-side CSA of VM, and operative-side CTV of the VL were significantly associated with increased PA after TKA. The ROC-calculated cutoff value was 10.2 cm2. Conclusions: These results suggested that preoperative muscle quantity and quality, particularly in the VM, could play important roles in postoperative PA outcomes after TKA.

The Effect of Modified Hybrid Training and NMES on Quadriceps Femoris and Hamstrings Muscle Endurance in Healthy Untrained Subjects

The Effect of Modified Hybrid Training and NMES on Quadriceps Femoris and Hamstrings Muscle Endurance in Healthy Untrained Subjects

From breast cancer diagnosis to survivorship: analyzing perioperative biopsychosocial phenotypes and their relationship to pain on long term.

Persistent breast cancer treatment-related pain affects up to 40% of patients, decreasing their quality of life (QoL). While current research typically utilizes correlation and regression analysis to identify biopsychosocial phenotypes contributing to this pain, this study employs cluster analysis to identify qualitatively different phenotypes based on somatosensory and psychosocial characteristics both before and one week post-breast cancer surgery. Further, it investigates how these phenotypes are related to pain intensity one year post-surgery and examines the evolution of phenotype membership from pre- to post-surgery. Somatosensory and psychosocial functioning was evaluated pre- and post-surgery in 184 women undergoing unilateral breast cancer surgery. Eight different quantitative sensory testing (QST) methods including mechanical detection and pain thresholds, pressure pain thresholds, thermal detection and pain thresholds, and conditioned pain modulation were performed at the surgical area (trunk, arm, major pectoral muscle) and a distant location (quadriceps muscle). Psychosocial functioning was assessed using the Central Sensitization Inventory, Pain Catastrophizing Scale, Depression Anxiety Stress Scale-21, and the McGill Quality of Life Questionnaire. Pain intensity was evaluated one year post-breast cancer surgery using the Visual Analogue Scale. Latent class analysis identified five distinct phenotypes before and post-surgery, characterized by differences in mechanical and pain thresholds alongside psychosocial factors. Moreover, higher psychosocial distress and lower QoL correlated with elevated pain intensity one year post-surgery. These findings underscore the importance of addressing breast cancer patients' mental health perioperatively. Therefore, future research should explore whether psychological interventions perioperatively can reduce long-term pain intensity. PerspectiveThis secondary analysis, utilizing cluster analysis, reveals five distinct phenotype based on somatosensory and psychosocial characteristics both before and post breast cancer surgery. Higher psychosocial distress and lower quality of life correlated with elevated pain intensity one year post-surgery, emphasizing the need to address patients' mental health perioperatively. Trial registrationclinicaltrials.gov (NCT03351075)

Effects of Neuromuscular Electrical Stimulation on Quadriceps Femoris Muscle Strength and Knee Joint Function in Patients After ACL Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Quadriceps weakness is a common barrier to effective rehabilitation after anterior cruciate ligament (ACL) surgery. Neuromuscular electrical stimulation (NMES)-the application of electrical currents to induce muscle contraction-has been used as part of the postoperative rehabilitation regimen. To investigate the effects of NMES on the recovery of quadriceps strength and knee function after ACL surgery. Systematic review; Level of evidence, 1. A search was conducted in the Web of Science, Embase, Cochrane Library, and PubMed databases between inception and August 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were randomized controlled trials of patients undergoing NMES as postoperative rehabilitation after ACL reconstruction or repair, with standard physical therapy as the control intervention. The quality of the included studies was assessed according to the Cochrane Collaboration risk-of-bias tool. Lower limb function was assessed qualitatively, and standardized mean differences (SMDs) in muscle strength and Lysholm scores were analyzed quantitatively and pooled using a random-effects model. Eleven studies (N = 202 patients) met our inclusion criteria. The meta-analysis of muscle strength values, which included 9 studies, showed that patients who underwent physical rehabilitation with adjunctive NMES had better recovery and improvement in quadriceps muscle strength compared with standard physical therapy at both short- and long-term follow-ups (≤6 weeks: SMD, 0.53 [95% CI, 0.27-0.79] vs >6 weeks: SMD, 0.59 [95% CI, 0.18-0.99]; p < 0.001). Moreover, subgroup analyses showed that earlier physical rehabilitation with the assistance of NMES resulted in better muscle strength recovery (≤1 week: SMD, 1.48 [95% CI, 0.80-2.17] vs >1 week: SMD, 0.44 [95% CI, 0.21-0.67]; p < 0.001). The meta-analysis of Lysholm scores, which included 3 studies, did not indicate any significant differences between the assisted NMES and control groups. Our study demonstrated that in both short- and long-term follow-up studies, postoperative rehabilitation with NMES after ACL surgery significantly increased quadriceps muscle strength compared with standard rehabilitation alone.

Neural structural alterations correlates of quadriceps muscle strength deficits in patients after anterior cruciate ligament reconstruction.

Persistent maladaptive changes of corticospinal tract (CST) and quadriceps strength deficits exist in patients with anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate the relationships between the structural alterations of CST and quadriceps muscle strength deficits in patients with ACLR. Twenty-nine participants who had undergone unilateral ACLR (29 males; age=32.61±6.72 years) were enrolled in a cross-sectional investigation. We chose CST as a region of interest and performed diffusion tensor imaging (DTI) that measured the microstructure of white matter tracts. Maximal voluntary isometric quadriceps muscle strength was assessed using a hand-held dynamometer. Simple and partial correlation analyses were performed between the DTI outcomes and quadriceps muscle strength deficits in patients with ACLR before and after controlling for age, sex, BMI, Tegner activity score, and graft type. Sub-group analyses were also performed to investigate the relationships between the DTI outcomes of CST structure and quadriceps muscle strength deficits according to the graft type before and after controlling for age, sex, BMI, and Tegner activity score. Lower limb symmetry index (LSI) of quadriceps muscle strength was associated with a higher ratio of radial diffusivity (RD, r=-0.379, p=0.042) in corticospinal tracts of the injured hemisphere to those of the non-injured hemisphere in ACLR patients after controlling for age, BMI, Tegner activity score and graft type. In subgroup analyses of ACLR patients with hamstring autografts, we found that higher injured quadriceps muscle strength was associated with higher axial diffusivity (AD, r=0.616, p=0.033) of CST structure and lower LSI of quadriceps muscle strength was associated with higher ratio of mean diffusivity (MD, r=-0.682, p=0.014) and RD (r=-0.759, p=0.004) in corticospinal tracts of the injured hemisphere to those of the non-injured hemisphere in ACLR patients after controlling for age, BMI, Tegner activity score. Decreased integrity (higher ratio of RD) of CST microstructure in ACLR patients was significantly associated with lower quadriceps limb symmetry index, which hinted that quadriceps muscle strength deficits of injured side may be a demyelinating process of CST microstructure in ACLR.

Immunomodulatory effects of calcium phosphate microspheres: influences of particle size on macrophage polarization and secretion patterns.

This study investigated the immunomodulatory effects of calcium phosphate (CaP) microspheres, focusing on how particle size influenced macrophage polarization and cytokine secretion patterns. SEM analysis revealed that HA microspheres predominantly exhibited a spherical shape with distinct sizes and sub-micro-sized pores. The average particle sizes for the S1, S2, and S3 groups were 17.36 μm, 27.59 μm, and 47.14 μm, respectively. In vitro experiments demonstrated that small-sized S1 microspheres were more readily phagocytosed by macrophages, leading to a pro-inflammatory M1 phenotype characterized by increased gene expression of iNos and inflammatory cytokines (IL-1β, IL-6, TNF-α), and a higher proportion of CCR7+ M1 macrophages. In contrast, the larger S2 and S3 microspheres favored an anti-inflammatory M2 phenotype, with higher expression of Arg and anti-inflammatory cytokines (IL-10), and greater proportions of CD206+ M2 macrophages. Additionally, HA microspheres were injected into mouse quadriceps muscles, revealing significant differences in immune cell infiltration and tissue response. The S1 microspheres induced a prolonged and more severe inflammatory response, while the S2 and S3 microspheres were embedded in cell-rich tissue with minimal inflammation or fibrosis. It indicated the potential of larger microspheres (S2 and S3) to create a more favorable immune microenvironment that supported faster and more effective tissue healing. These findings underscore the importance of optimizing microsphere size to achieve desired immunomodulatory effects, thereby enhancing their clinical efficacy.

Knee Pain Is Not Always the Knee.

» Lumbar spine pathology is a known cause of referred pain to the lower extremities and should be investigated as a possible source of knee pain, especially with patients in their sixth decade.» While primary knee pathology is common, spinal pathology should always be considered in older patients presenting with knee pain, especially in atraumatic cases where knee imaging does not correlate with complaints or examination findings.» Lumbar (L) 3-4 pathology is most commonly affected in referred knee pain, with the 2 most common pathologies being spinal stenosis and disc herniation.» If knee radiographs do not demonstrate major pathology that correlates with a patient's history and examination, a thorough spine examination should then be performed with attention paid to patellar tendon reflex, quadriceps muscle strength, and any loss of sensation, as these can be hallmarks of L3-4 pathology.