Quadriceps Muscle Group Research Articles

Grade III Direct Head of Rectus Femoris Myotendinous Tear in a Recreational Athlete, a Case Report

The rectus femoris is a principal muscle in the quadriceps muscle group. It plays a major role in flexion of the hip and extension of the knee joint and works as an important dynamic stabilizer for both joints. This case report details the presentation, diagnosis, and treatment of a high-grade rectus femoris tear in a young physically active patient. Furthermore, we detail the mechanism of injury, clinical signs, and symptoms, in addition to images and findings used to confirm the diagnosis. Different treatment approaches are highlighted. The outcomes of conservative management in comparison with surgical intervention is explored in the literature. The aim of this case study was to contribute more to the understanding of rectus femoris tears and to shed light on various aspects associated with this rare injury.

Quadriceps Crush Contusion in Athletes: The Effectiveness of Orthobiologic Treatment with Platet-Rich Plasma (PRP)

Introduction: Quadriceps contusion is a common injury in contact sports like football, rugby, and basketball, resulting from a direct blow to the anterior thigh. This causes muscle damage, bleeding, and inflammation. While often considered minor, poor management can lead to complications, delayed recovery, and impaired athletic performance. Purpose: The purpose of this review is to evaluate the effectiveness and the role of orthobiologic treatments such as PRP in enhancing healing and functional recovery for a swift return to sport. Summary: Quadriceps contusion, resulting from direct trauma to the quadriceps muscle group, leads to hematoma formation and varying degrees of injury severity. Diagnosis is primarily clinical, often supported by ultrasound and MRI to assess the extent of muscle damage. Treatment is typically non-operative, involving rest, ice, compression, physical therapy, and a gradual return to activity. One significant complication is myositis ossificans, characterized by abnormal bone formation within the muscle, which can cause chronic pain and restricted movement. Recent advances, such as ultrasound-guided PRP injections, offer promising results by enhancing healing, relieving pain, and accelerating functional recovery. PRP therapy, particularly popular among athletes, promotes tissue repair by stimulating cell regeneration and reducing inflammation, helping speed up recovery and potentially lowering the risk of complications like myositis ossificans. Although preliminary evidence supports the effectiveness of PRP in helping athletes return to play sooner, more research is needed to validate its full impact on musculoskeletal injuries. Continued exploration of nonoperative treatment and rehabilitation protocols is also necessary to ensure optimal outcomes. Preventive strategies, including the use of protective gear and conditioning exercises to strengthen muscles, are critical in reducing the risk of injury and enhancing athletic performance.

Relationship between quadriceps muscle architecture and lower limb strength and physical function in older adults community-dwelling individuals: a cross-sectional study.

Factors related to muscle architecture may lead to functional limitations in activities of daily living in the older adults. This study aimed to investigate the relationship between quadriceps femoris (QF) architecture and physical function in older adults community-dwelling people. The study included 25 community-dwelling older adults participants aged over 60 years (14 women and 11 men) who were not engaged in regular physical activity. The rectus femoris (RF) and vastus intermedius (VI) muscle thicknesses as well as the RF cross-sectional area (CSA) were assessed using 2D ultrasonography. The 30 Seconds Chair Stand test (30sCST) and Timed Up and Go Test (TUG) were used to assess lower body muscle power and functional mobility, respectively. The QF muscle architecture showed moderate and large correlations with the 30sCST (r range = 0.45-0.67, p < 0.05) and TUG (r range = 0.480-0.60, p < 0.05). RF thickness was a significant (p < 0.01) independent predictor of 30sCST (R 2 = 0.45) and TUG (R 2 = 0.36). VI thickness was a significant (p < 0.05) independent predictor of 30sCST (R 2 = 0.20) and TUG (R 2 = 0.231). RF CSA was a significant independent predictor of the 30sCST (R 2 = 0.250, p < 0.05) and TUG (R 2 = 0.27, p < 0.01). Multiple linear regression models explained 38% of the 30sCST variance and 30% of the TUG variance in the older adults group. Quadriceps muscle group directly affects basic activities of daily living in the older adults. Ultrasound measurements, which are non-invasive tools, are extremely valuable for understanding the limitations of activities of daily living in the older adults.

Addition of Blood Flow Restriction in Squat Exercises to Increase the Strength of Quadriceps Muscle Groups

Addition of Blood Flow Restriction in Squat Exercises to Increase the Strength of Quadriceps Muscle Groups

Exploring the quadriceps muscle architecture variations in various sports disciplines: a comparative analysis of football, taekwondo, and athletics.

The purpose of this study was to comprehensively investigate and compare the architecture of the quadriceps muscle in football, taekwondo, and athletics, shedding light on potential differences and providing valuable insights for athletic training and performance enhancement. Thirty-five athletes (football[N.]=14. [7 women, 7 men]; taekwondo [N.]=11. [6 women, 5 men]; athletics [N.]=10. [5 women, 5 men]) aged 17-21 years participated in the study. After participant demographic data were collected, 2D real-time B-mode ultrasound (USG) and right (R) and left (L) leg quadriceps muscle group rectus femoris (RF), vastus intermedius (VI), vastus lateralis, pennation angle (PA), RF cross-sectional area (CSA), and subcutaneous fat thickness were determined. In the study, in female athletes, R-RF+VI (P=0.04, ES:4.34), R-VI (P=0.01, ES: 6.1), R-RF: (P=0.009, ES: 7.9), R-CSA (P=0.04, ES: 5.2), L-RF (P=0.002, ES: 10.4) and L-CSA (P=0.007, ES: 7.7) significant differences were found in favor of the Football group. In male athletes, R-CSA (P=0.004, ES: 9.05), L-RF (P=0.05, ES: 3.5) and L-SFT (P=0.00, ES: 13.6), there was a significant difference in favor of the Football group. L-PA (P=0.009, ES: 6.2). L-PA (P=0.009, ES: 6.2) was significantly higher in the male Taekwondo group. Our research findings show that there is a significant relationship between the type of exercise performed and the structural differences observed in the quadriceps muscle. Consequently, it is highly recommended to consider the outcomes of our study for enhancing the efficacy of training programs in the domains of football, taekwondo, and athletics.

Evaluation of the Viscoelastic Properties of Lower-Extremity Muscles of Pediatric Hemophilia Patients Using Myotonometric Measurements.

This study aimed to evaluate the viscoelastic properties of lower-extremity muscles in pediatric hemophilia (FVIII-IX) patients. The study included 20 severe- and moderate-type right-dominant hemophilia patients diagnosed with hemophilia A-B and 20 healthy children. Viscoelastic properties (tone, stiffness, elasticity) of the lower-extremity muscles were measured using a MyotonPRO device. The physical characteristics of the pediatric hemophilia patients (mean age: 11.9 ± 3.95 years) and the control group (mean age: 12.6 ± 3.41 years) were found to be similar. A difference was observed only in the elasticity of the right vastus lateralis (p < 0.05) by means of the viscoelastic properties of the lower-extremity muscles. The results were similar in other muscle groups (p > 0.05). The dominant-side vastus lateralis muscle elasticity (the ability of the muscle to regain its original shape after contraction or removal of an external force) of hemophilia patients was found to be lower compared to healthy children. The fact that 45% of hemarthroses occur in the knee joint and that recurrent bleeding may affect the flexibility of the vastus lateralis, which is the main muscle within the quadriceps muscle group and responsible for the stabilization of the patella, can be associated with the study results.

Blood flow restriction: maintaining strength in the deltoid and quadriceps muscle groups during training interruption

Objective: to analyze intervention with pre-conditioning blood flow restriction, conditioning and bodybuilding inining the muscle strength of muscle groups during the interruption of training. Materials and Methods: 15 volunteers (men and women), with an average age of 25,0 ± 5,75 years, body weight 68,36 ± 10,6 kg and height 163,63 ± 8,8 cm, participated in the study. They were randomized and randomized into three groups: G1) was submitted to BFR has proved to be a more effective method, both pre-conditioning and conditioning, inining FM for longer, with intervals in training, in muscle groups, deltoid and quadriceps. Although, bodybuilding is also an option for this maintenance, but at lower levels than BFR, under two conditions that involve more actions and muscle groups when they are at stronger intensities. Various methods can increase and/or maintain muscle strength, including periods of exercise., with strength training, for eight weeks, on alternating days, and three weekly sessions; G2) to traditional strength training (muscle building), with periods and sessions equal to G1; and G3) to preconditioning ischemic training, with times and sessions equivalent to the previous groups. A database was created in Microsoft Excel to verify the Delta variation. Analysis was carried out in the Jeffrey’s Amazing Statistics Program (JASP), version 0.16.3 0 for Windows, which is used to measure the average, standard deviation, minimum and maximum; verify the normality of data by the Shapiro-Wilk test; and the Variance Analysis. (Anova one way). The adopted significance level was p≤0,05. Results: indicate that the muscle strength for the BFR group in the development exercise (p=0.001) and the size of the effect (η2=0.11) in the extender chair (p =0.044) and, effectively (η2.=0.61). Conclusion: BFR proved to be a more effective method, both pre-conditioning and conditioning, inining FM for longer, with intervals between training in the muscle, deltoid and quadriceps groups.

Functional electrical stimulation to enhance reactive balance among people with hemiparetic stroke.

Individuals with stroke demonstrate a twofold higher fall incidence compared to healthy counterparts, potentially associated with deficits in reactive balance control, which is crucial for regaining balance from unpredictable perturbations to the body. Moreover, people with higher stroke-related motor impairment exhibit greater falls and cannot recover balance during higher perturbation intensities. Thus, they might need supplemental agents for fall prevention or even to be included in a perturbation-based protocol. Functional electrical stimulation is a widely used clinical modality for improving gait performance;however, it remains unknown whether it can enhance or interfere with reactive balance control. We recruited twelve ambulatory participants with hemiparetic stroke (61.48 ± 6.77years) and moderate-to-high motor impairment (Chedoke-McMaster Stroke Leg Assessment ≤ 4/7). Each participant experienced 4 unpredicted paretic gait-slips, with and without functional electrical stimulation (provided 50-500ms after perturbation) in random order. The paretic quadriceps muscle group was chosen to receive electrical stimulation, considering the role of support limb knee extensors for preventing limb-collapse. Outcomes includingprimary (laboratory falls), secondary (reactive stability, vertical limb support) and tertiary (compensatory step length, step initiation, execution time) measureswere compared between the two conditions. Participants demonstrated fewer falls, higher reactive stability, and higher vertical limb support (p < 0.05) following gait-slips with functional electrical stimulation compared to those without. This was accompanied by reduced step initiation time and a longer compensatory step (p < 0.05). The application of functional electrical stimulation to paretic quadriceps following gait-slips reduced laboratory fall incidence with enhanced reactive balance outcomes among people with higher stroke-related motor impairment. Our results lay the preliminary groundwork for understanding the instantaneous neuromodulatory effect of functional electrical stimulation in preventing gait-slip falls, future studies could test its therapeutic effect on reactive balance. Clinical registry number: NCT04957355.

Hamstring-to-quadriceps activation ratio during lower-limb strengthening exercises

ABSTRACT Multiple exercises included in strength training involve greater activation of the quadriceps compared to hamstring muscles, which may lead to knee joint imbalances. The aim of this study was to examine the ratio of surface electromyography (sEMG) activity hamstring and quadriceps muscle groups (hamstring-to-quadriceps activation ratio; H:Q EMG), as well as lateral to medial hamstring activation ratio (LH:MH) in parallel squat, Romanian deadlift, hip thrust, lying leg curl and seated knee extension. The H:Q EMG was greater during lying leg curl compared to other exercises during both the concentric and eccentric phase, however the Romanian deadlift and hip thrust also resulted in relatively high H:Q EMG. Pairwise comparisons revealed that LH:MH was greater in the parallel squat compared to the Romanian deadlift and hip thrust in the concentric phase, and compared to the Romanian deadlift and hip thrust during the eccentric phase. Our data suggests that the lying leg curl promotes the greatest hamstring activation and H:Q EMG, amongst the exercises investigated, while also providing relatively homogenous LH:MH. The lying leg curl should be considered as a primary exercise in rehabilitation and training programmes, aiming to proportionally activate LH:MH and increase H:Q EMG, which may improve knee muscle balance.

Validation of protein biological markers of lamb meat quality characteristics based on the different muscle types.

This work investigated the ability of 8 potential biomarkers (phosphoglycerate kinase-1 (PGK1), pyruvate kinase-M2 (PKM2), phosphoglucomutase-1 (PGM1), β-enolase (ENO3, myosin-binding protein-C (MYBPC1), myosin regulatory light chain-2 (MYLPF), troponin C-1 (TNNC1) and troponin I-1 (TNNI1)) to characterize meat quality by analyzing their relative abundance and enzymatic activity. Two different meat quality groups (Quadriceps femoris (QF) and Longissimus thoracis (LT) muscles) were selected at 24h postmortem from 100 lamb carcasses. The relative abundance of PKM2, PGK1, PGM1, ENO3, MYBPC1, MYLPF, and TNNI1 was significantly different between LT and QF muscle groups (P<0.01). Moreover, PKM, PGK, PGM, and ENO activity in LT muscle group was significantly lower than that in QF muscle (P<0.05). Suggesting that PKM2, PGK1, PGM1, ENO3, MYBPC1, MYLPF, and TNNI1 can be used as robust biomarkers of lamb meat quality, providing the reference for understanding the molecular mechanism of postmortem meat quality formation in future.

Protocol for a case–control prospective study to investigate the impact of Hepatic Encephalopathy on Nutritional Intake and Sarcopenia status in patients with end-stage LIVer disease: HENS-LIV study

IntroductionHepatic encephalopathy (HE) is a debilitating symptom of end-stage liver disease (ESLD), but there remains a paucity of evidence regarding its impact on nutritional status, nutritional intake, compliance with nutritional...

Ultrasonographic assessment of skeletal muscles after experimentally induced neurogenic inflammation (facet injury) in rats.

This study set out to examine ultrasonographic attributes of non-neurosegmentally (pectoral-forelimb) and neurosegmentally linked (hindlimb) myotomes in an experimental model that leads to neurogenic inflammation in segmentally linked myotomes, and to evaluate quantitative correlations among ultrasonographic attributes of the muscles, relative content of various inflammatory mediators, and nociceptive thresholds (hot and mechanical) in rats. Twelve male Wistar Kyoto rats were randomly divided into two equinumerous groups: surgery group, in which the left lumbar (L4-L6) facet joints were compressed for 3 min with modified Kelly forceps under general anesthesia, and sham-operated rats. All ultrasonograms were obtained with the Vevo 2100 Visual Sonic scanner connected to a 24-MHz transducer at four different time points: pre-surgery and 7, 14, and 21 days after surgical procedures. Digital ultrasonographic images of quadriceps femoris, hamstring, and pectoral-brachial muscle groups were analyzed using a polygonal meter region of interest placed on the largest cross-sectional area of the muscles displayed in Image ProPlus® analytical software to compute numerical pixel values and pixel heterogeneity (standard deviation of mean pixel values). On day 21, pain behavior tests (hot plate and von Frey) were performed and then all animals were euthanized. Protein expression of inflammatory mediators in biceps brachii and rectus femoris muscles was measured by Western blot. The most prominent differences in muscle echotextural attributes between the two subsets of rats occurred 14 days post-surgery in pectoral-brachial and quadriceps femoris muscles. The expression of calcitonin-gene-related peptide was directly related to both echotextural variables only in biceps brachii (pixel intensity: r = 0.65, P = 0.02; and heterogeneity: r = 0.66, P = 0.02, respectively). Our findings have revealed the occurrence of echotextural changes in skeletal muscles of rats during myositis; however, the accumulation of inflammatory mediators and the outcomes of sensory tests did not relate to the changes in first-order echotextural characteristics of affected hindlimb muscles.

Relationship between Unilateral Leg Extension Strength and Dynamic Balance in Healthy Young Men

It is well known that the quadriceps muscle group is involved in activity during dynamic balance and that dynamic balance tests are an important feedback tool for predicting lower limb injuries. However, the relationship between maximum leg extension strength and performance in the Y Balance Test is not fully known. The aim of this study was to investigate the relationship between unilateral leg extension strength and dynamic balance in healthy young men. The study was conducted as a cross-sectional study. A total of 33 healthy men (mean age ± standard deviation = 21.21 ± 1.24 years) volunteered for this study. The participants’ dynamic balance was determined with the Y Balance Test and unilateral one repetition maximum strength was determined by the leg extension machine. The same side was preferred for strength and dynamic balance measurements. Normalized reach, composite score, and absolute and relative strength values were analyzed for correlations. Linear regression analysis was used to determine whether strength values predicted the results of the Y Balance Test. There was a positive linear correlation between the strength values and normalized reach distances and composite scores (r ranges from 0.466 to 0.757; p &lt; 0.01). The coefficients of determination showed that dynamic balance and strength (absolute and relative) performance are not independent parameters in healthy young men (r2 = 21–57% explained variance). It was also found that strength values (absolute and relative) can predict balance. Our study confirmed the relationship between strength and dynamic balance. It can be said that especially the strength of the lower extremity has an acceptable effect on dynamic balance.

Effect Of Eccentric Training And Isolytic Contraction To Improve Flexibility Of Quadriceps In Recreational Marathoners.

In the field of athletics, running is one of the most popular activities having beneficial health effects as well as negative effects during sports injury. Not only elite marathoners, but recreational marathoners have various lower limb musculoskeletal injuries that occur quite frequently which produces an adverse effect over the performance of the marathoners. Studies have suggested that the most common muscles that were affected were quadriceps group of muscles as well as the hamstrings muscles. The main mechanism behind the injury to the quadriceps muscles is the strong contraction of the muscle against the forced flexion action of the knee joint which is commonly seen in runners in a downhill marathon. Some of the risk factors that are responsible for the quadriceps muscle strains are inadequate stretching, muscle imbalance of the lower extremity and inadequate warm-up before vigorous exercise. Objective of this study was to find out the effect of eccentric training and whether isolytic contraction helps to improve the flexibility of the quadriceps muscle and joint range of motion of knee as well as hip joint. A total of 30 subjects were selected for the study from Krishna College of Physiotherapy. The subjects were divided into two groups namely, group A and group B consisting of 15 subjects each. Demographic data, assent and consent was taken from the marathoners that were selected according to the inclusion criteria. Pre and post assessment was taken on the basis of both active range of motion of the hip joint, active range of motion of knee joint, Manual Muscle Test of the quadriceps and Ely’s test for quadriceps before and after 6 weeks (total 16 sessions) of the treatment respectively. The session lasted for a time period of 45 mins. After the data was collected, evaluation and interpretation of collected data was done thoroughly. The subjects under the eccentric training protocol were found to have more effect compared to the ones in the group consisting of isolytic contraction protocol. The conclusion of this study was that significant effect of eccentric training and isolytic contraction helps to improve the flexibility of the quadriceps muscle and joint range of motion.

A newly discovered membrane at the origin of the proximal tendinous complex of the rectus femoris

PurposeThe rectus femoris (RF) forms the anterior portion of the quadriceps muscle group. It has a proximal tendinous complex (PTC) which is constituted by a direct tendon (DT), an indirect tendon (IT), and a variable third head. Direct and indirect tendons finally converge into a common tendon (CT). All the PTC shows a medially sloping in its proximal insertion.We investigated several anatomical specimens and discovered a new component: a membrane connecting the CT with the anterior superior iliac spine. Such membrane constitutes a new origin of the PTC. The aim of this study was to clarify whether this membrane was an anatomical variation of the PTC or a constant structure and to describe its morphology and trajectory.Material and methodsWe dissected 42 cadaveric lower limbs and examined the architecture of the PTC. We paid special attention to the morphology and interaction patterns between the tendons and the membrane.ResultsWe demonstrated that the membrane is a constant component of the PTC. It has a lateral to medial trajectory and is in relation to the common tendon, the DT, and IT, which present a medial slope. This suggests that the membrane has an stabilizer role for the PTC, acting as a corrector of the inclined vector of the complex.ConclusionThe RF injuries are frequent in football. The newly discovered membrane is a constant component of the PTC and its integrity should be included in the algorithm to diagnose injuries.

The Effect of Lower Limb Neuromuscular Electrical Stimulation on Skeletal Muscle Signaling for Glucose Utilization and Systemic Inflammation After Acute Spinal Cord Injury

<h3>Research Objectives</h3> To quantify the effects of a novel combination neuromuscular electrical stimulation (Comb-NMES) training program on muscle signaling for glucose utilization and systemic inflammatory blood markers in individuals with acute spinal cord injury (SCI). <h3>Design</h3> Randomized controlled clinical trial. <h3>Setting</h3> In-patient rehabilitation setting. <h3>Participants</h3> 12 participants between 30.3 ±8.6, with an SCI between C6-L1, within 14 days of the SCI and with no history of diabetes, participated in the study. Muscle samples were collected from the Vastus Lateralis muscle within 14 days of SCI and before discharge from the Spain Rehabilitation hospital. <h3>Interventions</h3> The intervention group received Comb-NMES training program that combines dynamic contractions (resistance training) via high-frequency electrical stimulation with twitch contractions (aerobic training) via low-frequency electrical stimulation on the quadriceps muscle group on both legs. The control group received (sham treatment) passive dynamic exercise of the lower legs and transcutaneous electrical nerve stimulation (TENS). Interventions were given 3 times/week for 3-4 weeks. <h3>Main Outcome Measures</h3> Western blot analysis was performed to quantify signaling proteins (GLUT4, AMPKα, Hexokinase II, CaMKII, Akt, AS160, IRS-1, ACC, GS, and PI3 Kinase) for muscle glucose uptake. In addition, assays were performed to measure the serum proinflammatory and anti-inflammatory cytokines (IFN-γ, IL-10, IL-12p70, IL-1β, IL-6, IL-8, AND TNF-α). <h3>Results</h3> Protein expression for Akt, AMPKα, AS160, CaMKII, GLUT4, Hexokinase II, and PI3 Kinase and circulating levels of anti-inflammatory cytokine IL-10 and IFN-γ increased following Comb-NMES training program. <h3>Conclusions</h3> This preliminary data suggests that Comb-NMES training may increase the expression of proteins for glucose uptake and utilization in the paralyzed skeletal muscle. In addition, Comb-NMES training may increase circulating anti-inflammatory cytokines. This trial is ongoing, and results may change with a larger sample size. <h3>Author(s) Disclosures</h3> All authors listed in this abstract have no conflict of interest. this study is funded by NIH.

Prevalence, Clinical Characteristics, and Self-Reported Treatment of Exercise-Associated Muscle Cramping Differ Between 21.1- and 56-Km Running Race Entrants-SAFER XXII.

To determine whether the lifetime prevalence and clinical characteristics of exercise-associated muscle cramping (EAMC) differ between runners entering a 21.1- versus 56-km road race. Cross-sectional study. The 2012 to 2015 Two Oceans Marathon races (21.1 and 56 km), South Africa. Participants were consenting race entrants (21.1 km = 44 458; 56 km = 26 962) who completed an online prerace medical screening questionnaire. A history of EAMC. The main outcome variables were lifetime prevalence (%) and clinical characteristics (muscle groups affected, timing of occurrence, severity, frequency of serious EAMC, and self-reported treatment) of a history of EAMC. Differences between 56- and 21.1-km race entrants were explored (relative risk [RR]). The lifetime prevalence of EAMC was 12.8%, which was higher in 56- (20.0%; 95% CI 19.5-20.6) versus 21.1-km race entrants (8.5%; 8.2-8.8) ( P = 0.0001). In all entrants, the fourth quarter was the most common onset (46.4%), calf muscles were the most commonly affected (53.1%), and most EAMCs were of mild-to-moderate severity (95%). In 56- versus 21.1-km entrants, hamstring (RR = 1.7; 1.5-1.9) and quadriceps muscle groups (RR = 1.5; 1.3-1.7) were more frequently affected ( P = 0.0001), the onset of EAMC during racing was less common in the first quarter (RR = 0.3; 0.2-0.4) ( P = 0.0001), and serious EAMC was more frequent (RR = 1.6; 1.4-1.9) ( P = 0.0001). In 56- versus 21.1-km runners, a history of EAMC is 2 times more frequent and muscle groups affected, onset in a race, and severity of EAMC differed. The lifetime prevalence was lower than previously reported in other events. Risk factors associated with EAMC may differ between entrants for different race distances.

Architectural anatomy of the quadriceps and the relationship with muscle strength: An observational study utilising real-time ultrasound in healthy adults.

Quadriceps atrophy and morphological change is a known phenomenon that can impact significantly on strength and functional performance in patients with acute or chronic presentations conditions. Real-time ultrasound (RTUS) imaging is a noninvasive valid and reliable method of quantifying quadriceps muscle anatomy and architecture. To date, there is a paucity of normative data on the architectural properties of superficial and deep components of the quadriceps muscle group to inform assessment and evaluation of intervention programs. The aims of this study were to (1) quantify the anatomical architectural properties of the quadriceps muscle group (rectus femoris, vastus intermedius, and vastus lateralis) using RTUS in healthy older adults and (2) to determine the relationship between RTUS muscle parameters and measures of quadriceps muscle strength. Thirty middle aged to older males and females (age range 55-79years; mean age=59.9±7.08years) were recruited. Quadriceps muscle thickness, cross-sectional area, pennation angle, and echogenicity were measured using RTUS. Quadriceps strength was measured using hand-held dynamometry. For the RTUS-derived quadriceps morphological data, rectus femoris mean results; circumference 9.3cm; CSA 4.6cm2 ; thickness 1.5cm; echogenicity 100.2 pixels. Vastus intermedius mean results; thickness 1.8cm; echogenicity 99.1 pixels. Vastus lateralis thickness 1.9cm; pennation angle 17.3°; fascicle length 7.0cm. Quadriceps force was significantly correlated only with rectus femoris circumference (r=0.48, p=0.007), RF echogenicity (r=0.38, p=0.037), VI echogenicity (r=0.43, p=0.018), and VL fascicle length (r=0.43, p=0.019). Quadriceps force was best predicted by a three-variable model (adjusted R2 =0.46, p<0.001) which included rectus femoris echogenicity (B=0.43, p=0.005), vastus lateralis fascicle length (B=0.33, p=0.025) and rectus femoris circumference (B=0.31, p=0.041). Thus respectively, rectus femoris echogenicity explains 43%, vastus lateralis fascicle length explains 33% and rectus femoris circumference explains 31% of the variance of quadriceps force. The study findings suggest that RTUS measures were reliable and further research is warranted to establish whether these could be used as surrogate measures for quadriceps strength in adults to inform exercise and rehabilitation programs.

KNEE RADIOGRAPHS DEMONSTRATE SMALL BUT STATISTICALLY SIGNIFICANT INCREASE IN POSTERIOR TIBIAL SLOPE IN PATIENTS WITH OSGOOD-SCHLATTER DISEASE

Background:Previous research has demonstrated an association between Osgood-Schlatter disease (OSD) and increased posterior tibial slope (PTS) in a small subset of patients with MRI and clinical exam consistent with OSD.Hypothesis/Purpose:To determine if children diagnosed clinically with OSD have an increased PTS on routine radiographs compared to controls.Methods:Patients 10-18 years old with the clinical diagnosis of OSD and a true lateral knee X-ray between 2016 and 2019 were eligible for the OSD group. Subjects were excluded if they had other significant knee pathology (Figure 1). The same number of controls were selected from patients in the same age and date range with history of anterior knee pain and a true lateral knee X-ray but no evidence of OSD or other significant pathology on clinical exam or X-ray. Demographic data and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores were collected for each subject. PTS measurements were performed on true lateral X-Rays by three blinded investigators. Independent samples t-test and chi-squared test were used to compare variable means and frequency between OSD and control knees. Logistic regression analysis was used to investigate the effects of OSD, age, sex, height, weight, and HSS Pedi-FABS score on PTS (≥12º versus <12º).Results:258 total knees (129 with OSD and 129 controls) were included. Mean age was 12.9 ± 1.8 years and 53% knees were male. There were no differences in age, sex, BMI, or laterality of knees between groups (Table 1). Mean PTS was significantly higher in the OSD group (11.6º ± 2.9º) compared to the control group (9.3º ± 2.7º, p<0.0001). In the OSD group, 46% of knees had a PTS ≥12º and in the control group, 19% knees had a PTS >12º (p<0.001). Logistic regression analysis showed that patients with OSD had 3.63 greater odds (95% CI 1.78-7.40) of having PTS ≥12º compared to patients without OSD, when controlling for age, sex, height, weight, and HSS Pedi-FABS score (Table 2).Conclusion:This study further supports an association between OSD and a mild increase in PTS. Patients with OSD had 3.6 greater odds of having PTS≥12º. The clinical implications of this finding have not yet been elucidated. We speculate that in patients with OSD, stresses (or force) exerted from the quadriceps muscle group through the patellar tendon loads the anterior portion of the tibia tubercle disproportionately to the posterior segment and causes asymmetric growth and an increased PTS.Tables/ FiguresFigure 1.Flowchart depicting OSD group patient exclusion.

Effect of rehabilitation robot rehabilitation training synchronizing acupuncture exercise therapy on postoperative rehabilitation with hip fracture

To compare the therapeutic effect between rehabilitation robot rehabilitation training synchronizing acupuncture exercise therapy and simple acupuncture exercise therapy on lower limb function and life activity ability for postoperative patients with hip fracture. A total of 50 elderly postoperative patients with hip fracture were randomly divided into an observation group and a control group, 25 cases in each group. Both groups were treated with acupuncture at hip three points of the affected side and lateral line 1 of vertex, anterior oblique parietotemporal line of the healthy side, hip three needles were retained for 30 min. The scalp acupuncture needles were continue retained, the observation group was given acupuncture exercise therapy to synchronize lower limb rehabilitation robot rehabilitation training, and the control group was given acupuncture exercise therapy. The two groups were treated once a day, 7 times as a course of treatment, and totally 4 courses were required. The Harris score, Barthel index score and quadriceps femoris isokinetic muscle strength indexes [peak torque (PT), average power (AP), flexor peak torque/extensor peak torque (F/E)] were compared between the two groups before and after treatment. After treatment, the Harris score, Barthel index score, PT and AP were higher than those before treatment (P<0.05), and F/E was lower than that before treatment in the two groups (P<0.05). After treatment, the Harris score, Barthel index score, PT and AP in the observation group were higher than those in the control group (P<0.05), and the F/E in the observation group was lower than that in the control group (P<0.05). Rehabilitation robot rehabilitation training of lower limbs synchronizing acupuncture exercise therapy could enhance the hip joint activity function and quadriceps muscle group function of elderly postoperative patients with hip fracture, and effectively improve the lower limb function and life activity ability.