Quadriceps Muscle Volume Research Articles

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.

Lower Extremity Muscle Volume in Unilateral and Bilateral Patellofemoral Pain: A Cross-Sectional Exploratory Study Including Superficial and Deep Muscles.

Existing patellofemoral pain (PFP) literature has primarily been focused on quadriceps muscle volume, with limited attention given to the deep and superficial muscle volume of the lower limbs in individuals with unilateral and bilateral PFP. In this paper, we aim to fill this gap. To explore superficial and deep lower extremity muscle volume in women with unilateral or bilateral PFP compared with a normative database of pain-free women. Cross-sectional study. University imaging research center. Twenty women with PFP (10 unilateral and 10 bilateral) and 8 pain-free women from a normative database. We quantified lower extremity muscle volume via 3.0-T magnetic resonance imaging. Two separate 1-way analyses of variance were performed: (1) unilateral PFP (painful versus nonpainful limb) versus pain-free control groups and (2) bilateral PFP (more painful versus less painful limb) versus pain-free control groups. We observed no differences in age and body mass index across groups (P > .05). Compared with the pain-free group, the unilateral and bilateral PFP groups had bilaterally smaller volumes of the anterior (iliacus: P ≤ .0004; d range, 2.12-2.65), medial (adductor brevis, adductor longus, gracilis, and pectineus: P ≤ .02; d range, 1.25-2.48), posterior (obturator externus, obturator internus, and quadratus femoris: P < .05; d range, 1.17-4.82), and lateral (gluteus minimus: P ≤ .03; d range, 1.16-2.09) hip muscles and knee extensors (rectus femoris: P ≤ .003; d range, 1.67-2.16) and flexors (long and short head of the biceps femoris: P ≤ .01, d range, 1.56-1.93). Women with unilateral and those with bilateral PFP displayed less volume of multiple superficial and deep muscles of the bilateral hips and knees than pain-free women. Interventions should bilaterally target lower limb muscles when treating PFP, and hypertrophy exercises for specific muscles should be explored to increase choices for intervention.

Blood Flow Restriction Enhances Recovery After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Controlled Trials

To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating neuromuscular and clinical outcomes of blood flow restriction (BFR) training after anterior cruciate ligament reconstruction (ACLR) compared with non-BFR rehabilitation protocols. A systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic reviews and Meta Analyses guidelines by querying PubMed, MEDLINE, Scopus, the Cochrane Database for Systematic Review, and the Cochrane Central Register for Controlled Trials databases from inception through December 2023 to identify Level I and II RCTs evaluating outcomes of BFR training after ACLR compared with non-BFR rehabilitation. A meta-analysis was performed using random-effects models with standardized mean difference (SMD) for pain, muscle strength, and muscle volume, whereas mean difference was calculated for patient-reported outcome measures. Eight RCTs, consisting of 245 patients, met inclusion criteria, with 115 patients undergoing non-BFR rehabilitation compared with 130 patients undergoing BFR after ACLR. Mean patient age was 27.2 ± 6.7 years, with most patients being male (63.3%, n= 138/218). The length of the BFR rehabilitation protocol was most commonly between 8 and 12 weeks (range, 14 days to 16 weeks). Most studies set the limb/arterial occlusion pressure in the BFR group at 80%. When compared with non-BFR rehabilitation, BFR resulted in significant improvement in isokinetic muscle strength (SMD: 0.77, P= .02, I2: 58%), International Knee Documentation Committee score (mean difference: 10.97, P ≤ .00001, I2: 77%), and pain (SMD: 1.52, P= .04, I2: 87%), but not quadriceps muscle volume (SMD: 0.28, P= .43, I2: 76%). The use of BFR after ACLR led to improvements in pain, International Knee Documentation Committee score, and isokinetic muscle strength, with variable outcomes on the basis of quadriceps strength, volume, and thickness when compared with non-BFR rehabilitation. Level II, systematic review and meta-analysis of Level I and II studies.

Vitamin D as an intervention for improving quadriceps muscle strength in patients after anterior cruciate ligament reconstruction: study protocol for a randomized double-blinded, placebo-controlled clinical trial

BackgroundThe goal of anterior cruciate ligament reconstruction (ACLR) is to restore the preinjury level of knee function to return to play (RTP). However, even after completing the rehabilitation programme, some patients may have persistent quadriceps muscle weakness affecting knee function which ultimately leads to a failure in returning to play. Vitamin D has been long recognized for its musculoskeletal effects. Vitamin D deficiency may impair muscle strength recovery after ACLR. Correcting vitamin D levels may improve muscle strength.MethodsThis is a double-blinded, randomized controlled trial to investigate the effects of vitamin D supplementation during the post-operative period on quadriceps muscle strength in anterior cruciate ligament (ACL)-injured patients. Patients aged 18–50 with serum vitamin D < 20 ng/ml, unilateral ACL injury, > 90% deficit in total quadriceps muscle volume on the involved leg compared with uninvolved leg, Tegner score 7 + , and no previous knee injury/surgery will be recruited. To assess patient improvement, we will perform isokinetic and isometric muscle assessments, ultrasound imaging for quadriceps thickness, self-reported outcomes, KT-1000 for knee laxity, biomechanical analysis, and Xtreme CT for bone mineral density. To investigate the effect of vitamin D status on quadriceps strength, blood serum samples will be taken before and after intervention.DiscussionPatients with low vitamin D levels had greater quadriceps fibre cross-sectional area loss and impaired muscle strength recovery after ACL. The proposed study will provide scientific support for using vitamin D supplementation to improve quadriceps strength recovery after ACLR.Trial registrationClinicalTrials.gov NCT05174611. Registered on 28 November 2021.

Greater Protein Intake Emphasizing Lean Beef Does Not Affect Resistance Training-Induced Adaptations in Skeletal Muscle and Tendon of Older Women: A Randomized Controlled Feeding Trial

BackgroundAlthough experimental research supports that resistance training (RT), especially with greater dietary protein intake, improves muscle mass and strength in older adults, comparable research on tendons is needed. ObjectivesWe assessed the effects of a protein-rich diet emphasizing lean beef, compared with 2 control diets, on RT-induced changes in skeletal muscle and tendon size and strength in older women. MethodsWe randomly assigned women [age: 66 ± 1 y, body mass index (BMI): 28 ± 1] to groups that consumed 1) 0.8 g total protein/kg body weight/day from mixed food sources (normal protein control, n = 16); 2) 1.4 g/kg/d protein from mixed food sources (high protein control, n = 17); or 3) 1.4 g/kg/d protein emphasizing unprocessed lean beef (high protein experimental group, n = 16). Participants were provided with all foods and performed RT 3 times/wk, 70% of 1-repetition maximum for 12 wk. We measured quadriceps muscle volume via magnetic resonance imaging (MRI). We estimated patellar tendon biomechanical properties and cross-sectional area (CSA) using ultrasound and MRI. ResultsDietary intake did not influence RT-induced increases in quadriceps strength (P < 0.0001) or muscle volume (P < 0.05). We noted a trend for an RT effect on mean tendon CSA (P = 0.07), with no differences among diets (P > 0.05). Proximal tendon CSA increased with RT (P < 0.05) with no difference between dietary groups (P > 0.05). Among all participants, midtendon CSA increased with RT (P ≤ 0.05). We found a decrease in distal CSA in the 0.8 g group (P < 0.05) but no change in the 1.4 g group (P > 0.05). Patellar tendon MRI signal or biomechanical properties were unchanged. ConclusionsOur findings indicated that greater daily protein intake, emphasizing beef, did not influence RT-induced changes in quadriceps muscle strength or muscle volume of older women. Although we noted trends in tendon CSA, we did not find a statistically significant impact of greater daily protein intake from beef on tendon outcomes.This trial was registered at clinicaltrials.gov as NCT04347447.

Examination of knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis

BackgroundJoint moment arm is a major element that determines joint torque. This study aimed to investigate factors associated with knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis. MethodsThirty-six participants with knee osteoarthritis (mean age, 78.1 ± 6.0 years) and 43 healthy controls (mean age, 73.0 ± 6.3 years) were analyzed. Magnetic resonance images (MRI) from the knee joint and thigh were acquired using a 3.0 T MRI scanner. The three-dimensional moment arm was defined as the distance between the contact point of the tibiofemoral joint and the patellar tendon line. The three-dimensional moment arm was decomposed into sagittal and coronal components, which were calculated as knee extensor and valgus moment arms, respectively. Quadriceps muscle volume, epicondylar width, bisect offset, Insall–Salvati ratio, and Kellgren–Lawrence grade were assessed. Multiple regression analyses were performed in the healthy control and knee osteoarthritis groups, with knee extensor and valgus moment arms as dependent variables. FindingsKnee extensor moment arm was significantly associated with epicondylar width and the Insall–Salvati ratio in the healthy control group and with Kellgren–Lawrence grade, epicondylar width, and quadriceps muscle volume in the knee osteoarthritis group. Valgus knee moment arm was significantly associated with bisect offset in both the groups. InterpretationKnee size, osteoarthritis severity, and quadriceps muscle volume affect the knee extensor moment arm in knee osteoarthritis, whereas lateral patellar displacement affects the valgus knee moment arms in older individuals with and without knee osteoarthritis.

Multimodal and conventional resistance training interventions improve muscle function in older adults: Findings from the Training IMCT study

Age-associated remodeling processes affect the intramuscular connective tissue (IMCT) network, which may significantly impair muscle function. Thus, we aimed to test whether including exercises shown to efficiently target the IMCT to a conventional resistance exercise intervention (CONV) would result in greater functional gains as compared to CONV alone. Fifty-three men and women (66.2 ± 3.3 years) were assigned to either CONV (n = 15), multimodal training (MULTI; n = 17) or a control (CTRL; n = 21) group. All subjects were tested at baseline, and those assigned to CONV or MULTI underwent a 16-week training intervention. The CONV group followed a progressive resistance training program, in which the number of weekly training sessions gradually increased from 1 to 3. In the MULTI group, one of these sessions was replaced with plyometric training, followed by self-myofascial release. Testing included maximal strength and power, imaging-based muscle volume, architecture, and functional performance. The intervention effects were analyzed using two- or three-way repeated measures ANOVA models (α = 0.05). Briefly, the maximal knee extension isometric contraction, one-repetition maximum, and isokinetic peak torque increased in all groups (p < 0.05), albeit to a lesser extent in CTRL. On the other hand, quadriceps femoris muscle volume (p = 0.019) and vastus lateralis pennation angle (p < 0.001) increased only in the MULTI group. Handgrip strength did not change in response to the intervention (p = 0.312), whereas Sit-to-Stand performance improved in all groups after the first 8-wks, but only in MULTI and CONV after 16-wks (all p < 0.001). In conclusion, we found that a resistance training intervention in which one weekly training session is replaced by plyometric training is feasible and as effective as a program consisting solely of conventional strength training sessions for inducing gains in muscle strength and function in older adults. Muscle size and architecture improved only in the MULTI group. German Clinical Trials: DRKS00015750.

Eight-week neuromuscular electrical stimulation training produces muscle strength gains and hypertrophy, and partial muscle quality improvement in the knee extensors

ABSTRACT This study investigated the effect of an 8-week neuromuscular electrical stimulation (NMES) training programme (3 days/week) on muscle quantity and quality and single-joint performance in the knee extensors. Thirty-nine untrained young male participants were randomly assigned to NMES training (n = 21) and control (n = 18) groups. The 8-week NMES training induced significant increase in the isometric maximal voluntary contraction (MVC) torque of the knee extensors (≈9.3%), muscle volume of the individual and entire quadriceps muscles determined by magnetic resonance imaging (≈3.3%–6.4%), and a significant decrease in the ultrasound echo intensity of the vastus lateralis (≈−4.0%); however, hypertrophy of the vastus intermedius (i.e., the deep muscle) was limited (≈3.3%). In the NMES training group, the repeated measures correlations of the isometric MVC torque with the muscle volume of the entire quadriceps muscle and each quadriceps muscle were significant (r rm (20) = 0.551–0.776), whereas that of the isometric MVC torque with the ultrasound echo intensity of the vastus lateralis was not significant. These findings suggest that NMES training produces muscle strength gains, muscle hypertrophy, and partial muscle quality improvement and that the NMES training-induced muscle strength gains is caused by muscle hypertrophy in the knee extensors.

Microgravity-induced skeletal muscle atrophy in women and men: implications for long-duration spaceflights to the Moon and Mars.

The inclusion of women on spaceflights has historically been limited. Recently, the first woman who will travel to the Moon was selected, and more women are participating in long-duration spaceflights. However, physiological data from real and simulated microgravity exposure are limited in women. This investigation studied women (n = 8, 34 ± 1 yr) and men (n = 9, 32 ± 1 yr) who underwent 2 (women) or 3 (men) mo of simulated microgravity (6° head-down tilt bed rest). Quadriceps and triceps surae muscle volumes were assessed via MRI before bed rest, bed rest day 29 (BR29, women and men), bed rest day 57 (BR57, women), and bed rest day 89 (BR89, men). Volume of both muscle groups decreased (P < 0.05) in women and men at all bed rest timepoints. Quadriceps muscle volume loss in women was greater than men at 1 mo (BR29: -17% vs. -10%, P < 0.05) and this 1-mo loss for women was similar to men at 3 mo (BR89: -18%, P > 0.05). In addition, the loss in women at 2 mo (BR57: -21%) exceeded men at 3 mo (P < 0.05). For the triceps surae, there was a trend for greater muscle volume loss in women compared with men at 1 mo (BR29: -18% vs. -16%, P = 0.08), and loss in women at 2 mo was similar to men at 3 mo (BR57: -29%, BR89: -29%, P > 0.05). The collective evidence suggests that women experience greater lower limb muscle atrophy than men at least through the first 4 mo of microgravity exposure. More sex-specific microgravity studies are needed to help protect the health of women traveling on long-duration orbital and interplanetary spaceflights.NEW & NOTEWORTHY This study adds to the limited evidence regarding sex-specific responses to real or simulated microgravity exposure, which collectively suggests a sex-specific muscle atrophy profile, with women losing more than men at least through the first 4 mo of weightlessness. Considering the increase in women being selected for space missions, including the first women to travel to the Moon, more physiological data on women in response to microgravity are needed.

Muscular Adaptations to Concurrent Resistance Training and High-Intensity Interval Training in Adults with Type 2 Diabetes: A Pilot Study.

This pilot study aimed to compare the effects of eight weeks of concurrent resistance training (RT) and high-intensity interval training (HIIT) vs. RT alone on muscle performance, mass and quality in adults with type 2 diabetes (T2DM). Twelve T2DM adults were randomly allocated to the RT + HIIT (n = 5) or RT (n = 7) group. Before and after training, maximal oxygen uptake (VO2max), muscle strength and power were evaluated by calorimetry, dynamometry and one-repetition maximum (1RM) test. Quadriceps muscle volume was determined by MRI, and muscle quality was estimated. After RT, VO2max (+12%), knee muscle power (+20%), quadriceps muscle volume (+5.9%) and quality (leg extension, +65.4%; leg step-up, +223%) and 1RM at leg extension (+66.4%), leg step-up (+267%), lat pulldown (+60.9%) and chest press (+61.2%) significantly increased. The RT + HIIT group improved on VO2max (+27%), muscle volume (+6%), muscle power (+9%) and 1RM at lat pulldown (+47%). No other differences were detected. Among groups, changes in muscle quality at leg step-up and leg extension and VO2max were significantly different. The combination of RT and HIIT effectively improves muscle function and size and increases cardiorespiratory fitness in adults with T2DM. However, HIIT combined with RT may interfere with the development of muscle quality.

A higher intramuscular fat in vastus medialis is associated with functional disabilities and symptoms in early stage of knee osteoarthritis: a case–control study

BackgroundThe characteristics of muscle degeneration in individual quadriceps in early knee osteoarthritis (OA) and the association of muscle quantity and quality on knee dysfunction remain unclear. This study aimed to clarify the characteristics of muscle degeneration in individual quadriceps muscles in early knee OA and elucidate the association of muscle volume and intramuscular adipose tissue (intraMAT) with knee dysfunction, including functional disabilities, symptoms, and joint morphology.MethodsFifty participants were categorized into early knee OA and healthy control groups. 3.0 T magnetic resonance imaging (MRI) using T1-weighted and Dixon methods and 3D SPACE in the thigh muscle and knee joint regions was performed. Quadriceps muscle volume, intraMAT, and whole-organ MRI score (WORMS) were assessed. The Knee Society Score (KSS) was used to evaluate functional disabilities and knee symptoms. Univariate analysis of variance was conducted with covariates to clarify the differences in muscle volume and intraMAT between the two groups. Multiple linear regression analyses were performed using the KSS function and symptom subcategories and WORMS as dependent variables and muscle volume, intraMAT, and the presence of early knee OA as independent variables, such as potential confounders.ResultsThe quadriceps intraMAT, especially in the vastus medialis (VM), was significantly higher in patients with early knee OA than in healthy controls. The VM intraMAT, not muscle volume, was significantly associated with KSS function [B = − 3.47; 95% confidence interval [CI], − 5.24 to − 1.71; p < 0.001] and symptom scores [B = − 0.63; 95% CI, − 1.09 to − 0.17; p = 0.008], but not with WORMS.ConclusionThese findings suggest that higher VM intraMAT is characteristic of quadriceps muscle degeneration in early knee OA and its increase is associated with functional disabilities and symptoms.

Impaired Physical Performance in X-linked Hypophosphatemia Is not Caused by Depleted Muscular Phosphate Stores.

X-linked hypophosphatemia (XLH) is a rare genetic disease, characterized by renal phosphate wasting and complex musculoskeletal manifestations including decreased physical performance. To characterize muscular deficits in patients with XLH and investigate phosphate stores in muscles. Case-control study (Muscle fatigability in X-linked Hypophosphatemia [MuXLiH]) with a 1-time assessment at the German Aerospace Center (DLR), Cologne, from May to December 2019, including patients with XLH cared for at the Osteology Department, University of Wuerzburg. Thirteen patients with XLH and 13 age/sex/body weight-matched controls aged 18-65 years were included. The main outcome measure was 31P-magnetic resonance spectroscopy (31P-MRS)-based assessment of phosphate metabolites in the soleus muscle at rest. Further analyses included magnetic resonance imaging-based muscle volume measurement, laboratory testing, isokinetic maximum voluntary contraction (MVC), fatigue testing, and jumping mechanography. By means of 31P-MRS, no significant differences were observed between XLH and controls regarding phosphate metabolites except for a slightly increased phosphocreatine to inorganic phosphate (PCr/Pi) ratio (XLH: 13.44 ± 3.22, control: 11.01 ± 2.62, P = .023). Quadriceps muscle volume was reduced in XLH (XLH: 812.1 ± 309.0 mL, control: 1391.1 ± 306.2 mv, P < .001). No significant differences were observed regarding isokinetic maximum torque (MVC) adjusted to quadriceps muscle volume. Jumping peak power and jump height were significantly reduced in XLH vs controls (both P < .001). The content of phosphoric compounds within the musculature of patients with XLH was not observed to be different from controls. Volume-adjusted muscle strength and fatiguability were not different either. Reduced physical performance in patients with XLH may result from long-term adaptation to reduced physical activity due to skeletal impairment.

Differing hypertrophy patterns from open and closed kinetic chain training affect quadriceps femoris center of mass and moment of inertia.

Purpose: To determine whether kinetic chain pattern during knee extensor strength training influences quadriceps femoris center of mass and moment of inertia about the hip in a predictable manner as such changes can affect running economy. Methods: Twelve participants completed 8weeks of both unilateral open (OKC) and closed (CKC) kinetic chain resistance training on opposing legs. Changes in quadriceps femoris muscle volume (VOLQF), center of mass location (CoMQF), and moment of inertia (I QF) about the hip were determined from magnetic resonance images scans. Regional hemodynamics of the vastus lateralis taken at 30% and 70% of muscle length during OKC and CKC bouts early in the training program were measured using near-infrared spectroscopy (NIRS) and used post hoc to predict changes in CoMQF. Results: While increases in VOLQF were similar between OKC (Δ79.5 ± 87.9cm3) and CKC (Δ60.2 ± 110.5cm3, p = 0.29), the patterns of hypertrophy differed; a distal shift in CoMQF (Δ2.4 ± 0.4cm, p < 0.001) and increase in I QF (Δ0.017 ± 0.014kgm2, p < 0.001) occurred in OKC but not in CKC (CoMQF: Δ-2.2 ± 2.0cm, I QF: Δ-0.022 ± 0.020kgm2, p > 0.05). Regional hemodynamics assessed by NIRS during a single training session displayed similar exercise and regional differences and predicted 39.6% of observed changes in CoMQF. Conclusions: Exercise selection influences muscle shape sufficiently to affect CoMQF and I QF, and these changes may be predicted in part from NIRS measurements during a single workout. Given I QF is inversely related to running economy and since CKC exercise provides a more proximal pattern of hypertrophy than OKC, it may be more preferential for running. The results from the present study also highlight the potential of NIRS as a tool for predicting patterns of hypertrophy between different exercises and exercise conditions.

Perioperative Essential Amino Acid Supplementation Facilitates Quadriceps Muscle Strength and Volume Recovery After TKA: A Double-Blinded Randomized Controlled Trial.

Perioperative essential amino acid (EAA) supplementation suppresses lower-limb muscle atrophy and promotes functional improvement in the first 4 weeks after total knee arthroplasty (TKA). However, its effect on the recovery of muscle volume and strength in the intermediate term is unclear. The aim of this study was to evaluate the effect of perioperative EAA supplementation on the recovery of lower-limb muscle volume and strength in the 2 years after TKA. Sixty patients who underwent unilateral TKA for primary knee osteoarthritis were included in this double-blinded randomized controlled trial. After excluding dropouts, 26 patients assigned to the EAA group (9 g/day) and 26 assigned to the placebo group (powdered lactose, 9 g/day) were available for analysis. Patients received EAA supplementation or a placebo from 1 week prior to surgery to 2 weeks after it. The rectus femoris muscle area was measured using ultrasonography and quadriceps muscle strength was measured isometrically with a handheld dynamometer, preoperatively and periodically up to 2 years postoperatively. Knee pain, knee range of motion, functional mobility, and Knee Society Score 2011 subjective scores were measured at each time point. Perioperative management, except for supplementation, was identical in the 2 groups. Taking the baseline as 100%, the mean values in the EAA and placebo groups were 134% ± 31% and 114% ± 27%, respectively, for the rectus femoris muscle area and 159% ± 54% and 125% ± 40% for the quadriceps muscle strength, respectively, at 2 years after surgery. The differences were significant (p < 0.05). Clinical outcomes were not significantly different between the 2 groups. Perioperative EAA supplementation contributes to the recovery of rectus femoris muscle volume and quadriceps muscle strength in the 2 years after TKA. The EAA supplementation did not impact clinical outcomes. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Is there a connection between individual thigh muscle volume and squat lifting velocity

Background&#x0D; Identifying key musculoskeletal and biomechanical criteria that are associated with Resistance Training (RT) is essential to avoid injury and optimise training outcome. Biomechanically, so-called velocity-based RT is an objective approach to directly quantify training intensity and effect. From a musculoskeletal perspective, RT enhances muscle force, which is correlated to the muscle’s physiological cross-sectional area, and thus muscle volume.&#x0D; Goal&#x0D; The goal of this study is to find out whether there exists a correlation between the change in lifting velocity during a squat set-to-exhaustion and the Hamstring to Quadriceps Muscle Volume Ratio (H/Q Ratio) as indicator of muscle strength.&#x0D; Methodology&#x0D; Ethical approval for this study was given by the Kantonale Ethikkommission Bern. Recreationally trained RT athletes (age 20-40years) were recruited through the investigator’s network. The methodology is divided into three parts. Firstly, the hamstring and quadriceps muscle volumes are determined using Magnetic Resonance Imaging (MRI) as gold standard. Thereby, the open-source software SASHIMI with an automatic tracking function is utilised to segment the MRI data. The segmented data is further processed with the Python programming language to derive the H/Q ratios. Secondly, lifting velocity during the squat is determined using data from optical motion capture (Vicon Nexus System with 10 infrared cameras) as gold standard. Thereby, a set-to-exhaustion is performed at 80% of each individual one repetition maximum (1RM), whereby the subjects are asked to complete the concentric phase at maximum speed to comply with velocity-based RT recommendations. Lifting velocity is derived from the tracked position of two reflective markers on the bar using the Python programming language. Thirdly, a statistical correlation analysis is conducted between the musculoskeletal and the biomechanical parameters. Statistical analysis is performed with the statistical analysis software R, with the level of significance set at p = 0.05.&#x0D; Results&#x0D; To date, MRI data have been acquired in five athletes and the corresponding muscle volumes have been determined (Quadriceps: 0.00525 +/-0.00185 m3 and Hamstrings: 0.0019 +/-0.007 m3). In addition, the load-velocity profiles have been derived in the same group of subjects. The MRI-based muscle volumes are in a similar range to previously published data (Maeo et al., 2021). Furthermore, the results of the load-velocity profiles show the anticipated decrease according to velocity-based RT guidelines (Rodriguez-Rosell et al., 2020).&#x0D; Discussion&#x0D; In a next step further data will be acquired in more subjects for subsequent statistical analysis. The outcome of the present study is expected to provide new scientific insights into the relationship between musculoskeletal and biomechanical criteria that affect squat performance. The insight may help to optimize velocity-based RT recommendations for individual athletes to maximise performance and reduce injury risks.&#x0D; References&#x0D; Rodríguez-Rosell, D., Yáñez-García, J. M., Sánchez-Medina, L., Mora-Custodio, R., &amp; González-Badillo, J. J. (2020). Relationship between velocity loss and repetitions in Reserve in the bench press and back squat exercises. Journal of Strength and Conditioning Research, 34(9), 2537–2547. https://doi.org/10.1519/JSC.0000000000002881&#x0D; Maeo, S., Huang, M., Wu, Y., Sakurai, H., Kusagawa, Y., Sugiyama, T., Kanehisa, H., &amp; Isaka, T. (2021). Greater hamstrings muscle hypertrophy but similar damage protection after training at long versus short muscle lengths. Medicine &amp; Science in Sports &amp; Exercise, 53(4), 825–837. https://doi.org/10.1249/MSS.0000000000002523

Effect of pulsed electromagnetic field as an intervention for patients with quadriceps weakness after anterior cruciate ligament reconstruction: a double-blinded, randomized-controlled trial

BackgroundThe ultimate goal of anterior cruciate ligament reconstructions (ACLR) is to fulfil the return-to-play (RTP) criteria. Quadriceps muscle strength is one of the key determinants for a patient’s successful return-to-play after ACLR. Quadriceps muscle atrophy can persist beyond the completion of the rehabilitation program in almost half the patients and the reason behind this is still unknown. There are emerging evidences showing that pulsed electromagnetic field (PEMF) can modulate mitochondrial activities for muscle gain. PEMF exposure on top of regular exercise training may promote muscle regeneration and tissue healing.MethodsThis is a double-blinded, randomized controlled trial to investigate the effects of PEMF treatment during the postoperative period on quadriceps muscle strength in ACL injured patient. Adult patients (aged 18–30) with a unilateral ACL injury, total quadriceps muscle volume is equal or more than 7% deficit on involved leg compared with uninvolved leg, sporting injury with a Tegner score of 7+, and both knees without a history of injury/prior surgery will be recruited. To estimate the improvement of patients, isokinetic muscle assessment, ultrasound imaging and MRI for quadriceps muscle thickness, self-reported outcomes with questionnaires, KT-1000 for knee laxity and biomechanical analysis, and Xtreme CT for bone mineral density will be performed. To investigate the mechanism of PEMF therapy on increasing quadriceps strength, samples of blood serum will be drawn before and after intervention.DiscussionThis is the first trial evaluating the effects of PEMF on quadriceps muscle recovery after ACLR. The proposed study addresses a huge research gap by evaluating practical use of PEMF as part of rehabilitation. The proposed study will provide much needed scientific support in the use of this noninvasive treatment modality to facilitate recovery of quadriceps strength after PEMF.Trial registrationClinicalTrials.gov NCT05184023. Registered on 5 January 2022

The Impact of Slice Interval and Equation on the Accuracy of Magnetic Resonance Image Estimation of Quadriceps Muscle Volume in End Stage Liver Disease.

IntroductionEnd stage liver disease (ESLD) is associated with loss of muscle mass and function, known as sarcopenia, which can increase the risk of complications of ESLD, hospitalization and mortality. Therefore, the accurate assessment of muscle mass is essential to evaluate sarcopenia in ESLD. However, manual segmentation of muscle volume (MV) can be laborious on cross-sectional imaging, due to the number of slices that require analysis. This study aimed to investigate the impact of reducing the number of slices required for MV estimation. Further, we aimed to compare two equations utilized in estimating MV (cylindrical and truncated cone).MethodsThirty eight ESLD patients (23 males; 54.8 ± 10.7 years) were recruited from the Queen Elizabeth University Hospital Birmingham. A 3T MRI scan was completed of the lower limbs. Quadriceps MV was estimated utilizing 1-, 2-, 3-, and 4 cm slice intervals with both cylindrical and truncated cone equations. Absolute and relative error (compared to 1 cm slice interval) was generated for 2-, 3-, and 4 cm slice intervals. L3 skeletal muscle index (SMI) was also calculated in 30 patients.ResultsRelative error increased with slice interval using the cylindrical (0.45 vs. 1.06 vs. 1.72%) and truncated cone equation (0.27 vs. 0.58 vs. 0.74%) for 2, 3, and 4 cm, respectively. Significantly, the cylindrical equation produced approximately twice the error compared to truncated cone, with 3 cm (0.58 vs. 1.06%, P < 0.01) and 4 cm intervals (0.74 vs. 1.72%, P < 0.001). Finally, quadriceps MV was significantly correlated to L3 SMI (r2 = 0.44, P < 0.0001).ConclusionThe use of the truncated equation with a 4 cm slice interval on MRI offers an efficient but accurate estimation of quadricep muscle volume in ESLD patients.

Quadriceps muscle volume has no effect on patellofemoral cartilage lesions in patients with end-stage knee osteoarthritis

PurposeThe quadriceps muscle has a positive effect on anterior knee pain. However, its effect on the patellofemoral (PF) cartilage in patients with end-stage knee osteoarthritis is unknown. The present study aimed to evaluate whether the quadriceps muscle area had a positive effect on the PF cartilage and whether this muscle had a positive effect on the clinical scores.Materials and methodsPatients with confirmed cartilage status and clinical scores who underwent total knee arthroplasty (TKA) were included. The PF cartilage status was evaluated during TKA. The thickness and the area of the quadriceps muscle were measured using a knee computed tomography scan obtained before the surgery. The Q-angle, hip–knee–ankle angle, alignment, and Insall–Salvati ratio were measured by radiography.ResultsAltogether, 204 patients were included in the study. Logistic regression was performed including factors associated with PF cartilage lesions. The regression model was found to be statistically significant (Hosmer–Lemeshow test, χ2 = 0.493). A smaller hip–knee–ankle (HKA) angle was associated with a higher incidence of PF cartilage lesions (p = 0.033) and only the alignment had an effect on the PF cartilage lesions. PF cartilage lesions did not correlate with the clinical scores. A thicker medial portion of the quadriceps muscle was associated with a significantly higher Knee Society Knee Score (KSKS) (p = 0.028).ConclusionsQuadriceps muscle thickness and area, Q-angle, and patellar height were not associated with PF cartilage lesions, while a smaller HKA angle was associated with PF cartilage lesions. The presence of PF cartilage lesions did not affect the clinical symptoms. However, a thicker medial portion of the quadriceps muscle was associated with a higher KSKS.

Daily protein-polyphenol ingestion increases daily myofibrillar protein synthesis rates and promotes early muscle functional gains during resistance training.

Factors underpinning the time-course of resistance-type exercise training (RET) adaptations are not fully understood. This study hypothesized that consuming a twice-daily protein-polyphenol beverage (PPB; n = 15; age, 24 ± 1 yr; BMI, 22.3 ± 0.7 kg·m-2) previously shown to accelerate recovery from muscle damage and increase daily myofibrillar protein synthesis (MyoPS) rates would accelerate early (10 sessions) improvements in muscle function and potentiate quadriceps volume and muscle fiber cross-sectional area (fCSA) following 30 unilateral RET sessions in healthy, recreationally active, adults. Versus isocaloric placebo (PLA; n = 14; age, 25 ± 2 yr; BMI, 23.9 ± 1.0 kg·m-2), PPB increased 48 h MyoPS rates after the first RET session measured using deuterated water (2.01 ± 0.15 vs. 1.51 ± 0.16%·day-1, respectively; P < 0.05). In addition, PPB increased isokinetic muscle function over 10 sessions of training relative to the untrained control leg (%U) from 99.9 ± 1.8 pretraining to 107.2 ± 2.4%U at session 10 (vs. 102.6 ± 3.9 to 100.8 ± 2.4%U at session 10 in PLA; interaction P < 0.05). Pre to posttraining, PPB increased type II fCSA (PLA: 120.8 ± 8.2 to 109.5 ± 8.6%U; PPB: 92.8 ± 6.2 to 108.4 ± 9.7%U; interaction P < 0.05), but the gain in quadriceps muscle volume was similar between groups. Similarly, PPB did not further increase peak isometric torque, muscle function, or MyoPS measured posttraining. This suggests that although PPB increases MyoPS and early adaptation, it may not influence longer term adaptations to unilateral RET.NEW & NOTEWORTHY Using a unilateral model of resistance training, we show for the first time that a protein-polyphenol beverage increases initial rates of myofibrillar protein synthesis and promotes early functional improvements. Following a prolonged period of training, this strategy also increases type II fiber hypertrophy and causes large individual variation in gains in quadricep muscle cross-sectional area.

Knee Extensor Morphology and Sprint Performance in Preadolescent Sprinters

ABSTRACT Purpose: We previously reported that the cross-sectional area of the quadriceps femoris is correlated with the sprint performance of preadolescent sprinters. This finding suggests a close relationship between knee extensor torque-enhancing morphology and sprint performance in this young population. To further clarify this issue, in this study, we examined the relationships of the quadriceps femoris muscle volume (MV) and knee extensor moment arm (MA) with sprint performance in preadolescent sprinters. Methods: The quadriceps femoris MV and knee extensor MA in 15 sprint-trained preadolescent boys were measured using magnetic resonance imaging. Sprint performance was evaluated using a personal best 100-m sprint time and the higher 50-m sprint velocity of two 50-m sprint tests. Results: The quadriceps femoris MV and knee extensor MA were significantly correlated with personal best 100-m sprint time (r = −0.810 and −0.752, P ≤ 0.001 for both) and 50-m sprint velocity (r = 0.814 and 0.702, P < .01 for both). Furthermore, the relative quadriceps femoris MV normalized to body mass was significantly correlated with both the personal best 100-m sprint time (r = −0.620, P = .014) and 50-m sprint velocity (r = 0.686, P = .005). In contrast, no significant correlations were observed between the relative knee extensor MA normalized to body height and both sprint performance parameters. Conclusions: These findings suggest that the quadriceps femoris size, rather than the knee extensor MA dimension, is a more important morphological factor for achieving superior sprint performance in preadolescent sprinters.