Decreased passive muscle stiffness of vastus medialis is associated with poorer quadriceps strength and knee function after anterior cruciate ligament reconstruction

He, Xin; Huang, Wan Yun; Leong, Hio Teng; Qiu, Ji Hong; Cheong, Chun; Fu, Sai‐Chuen; Ong, Michael; Yung, Patrick Shu‐Hang

doi:10.1016/j.clinbiomech.2021.105289

Cited by 9 publications

(6 citation statements)

References 57 publications

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“…Patients were asked to lie supine with hip and knee flexed to 30° for the measurements of the quadriceps and to lie prone with hip and knee flexed to 30° (measured via a goniometer) for the measurements of hamstring muscles, which is a method we previously established. 19 The measurement locations were determined as follows: VM, 20% of the distance from the midpoint of the medial patellar border to the anterior superior iliac spine; RF, half of the distance from the anterior superior iliac spine to the midpoint of the superior tip of the patella; VL, one-third of the distance from the midpoint of the lateral patellar border to the anterior superior iliac spine; ST and SM, half of the distance from the ischial tuberosity to the medial femoral epicondyle; and BF, half of the distance from the ischial tuberosity to the lateral epicondyle of the femur. 58 These positions have provided reliable readings in our previous work.…”

Section: Methodsmentioning

confidence: 99%

“…58 These positions have provided reliable readings in our previous work. 19 For each muscle, images were taken after the transducer was held at the measurement site for <10 seconds in order to confirm that the shear elastic modulus in the region of interest (ROI) had a stable color distribution. The mean Young modulus (kPa) of a circle with the diameter of 11cm set near the center of the ROI was calculated.…”

Section: Passive Muscle Stiffnessmentioning

confidence: 99%

“… 3 Decreased shear modulus of the vastus medialis (VM), associated with poor knee function, has been found in patients with ACLR when compared with healthy controls. 19 Poor recovery of these muscle properties may lead to poor knee functional performance and even unfavorable knee biomechanics, which increases the risk of ACL reinjury. However, whether deficits in muscle stiffness and muscle activation affect knee functional performance and dynamic knee stability is not fully understood.…”

mentioning

confidence: 99%

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Effects of Deficits in the Neuromuscular and Mechanical Properties of the Quadriceps and Hamstrings on Single-Leg Hop Performance and Dynamic Knee Stability in Patients After Anterior Cruciate Ligament Reconstruction

Qiu

Cao

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Understanding the role of neuromuscular and mechanical muscle properties in knee functional performance and dynamic knee stability after anterior cruciate ligament reconstruction (ACLR) may help in the development of more focused rehabilitation programs. Purpose: To compare the involved and uninvolved limbs of patients after ACLR in terms of muscle strength, passive muscle stiffness, muscle activation of the quadriceps and hamstrings, hop performance, and dynamic knee stability and to investigate the association of neuromuscular and mechanical muscle properties with hop performance and dynamic knee stability. Study Design: Cross-sectional study; Level of evidence, 3. Method: The authors studied the quadriceps and hamstring muscles in 30 male patients (mean ± SD age, 25.4 ± 4.1 years) who had undergone unilateral ACLR. Muscle strength was measured using isokinetic testing at 60 and 180 deg/s. Passive muscle stiffness was quantified using ultrasound shear wave elastography. Muscle activation was evaluated via electromyographic (EMG) activity. Hop performance was evaluated via a single-leg hop test, and dynamic knee stability was evaluated via 3-dimensional knee movements during the landing phase of the hop test. Results: Compared with the uninvolved limb, the involved limb exhibited decreased peak torque and shear modulus in both the quadriceps and hamstrings as well as delayed activity onset in the quadriceps ( P < .05 for all). The involved limb also exhibited a shorter hop distance and decreased peak knee flexion angle during landing ( P < .05 for both). Decreased peak quadriceps torque at 180 deg/s, the shear modulus of the semitendinosus, and the reactive EMG activity amplitude of the semimembranosus were all associated with shorter hop distance ( R 2 = 0.565; P < .001). Decreased quadriceps peak torque at 60 deg/s and shear modulus of the vastus medialis were both associated with smaller peak knee flexion angle ( R 2 = 0.319; P < .001). Conclusion: In addition to muscle strength deficits, deficits in passive muscle stiffness and muscle activation of the quadriceps and hamstrings were important contributors to poor single-leg hop performance and dynamic knee stability during landing. Further investigations should include a rehabilitation program that normalizes muscle stiffness and activation patterns during landing, thus improving knee functional performance and dynamic knee stability.

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Section: Methodsmentioning

confidence: 99%

Section: Passive Muscle Stiffnessmentioning

confidence: 99%

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confidence: 99%

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Effects of Deficits in the Neuromuscular and Mechanical Properties of the Quadriceps and Hamstrings on Single-Leg Hop Performance and Dynamic Knee Stability in Patients After Anterior Cruciate Ligament Reconstruction

Qiu

Cao

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Various studies that evaluated how the mechanical properties of the muscle affect the knee joint reported that RF and H muscle stiffness decreases with age and is crucial for the control of knee joint movement [10,26,42]. In a study evaluating muscle stiffness after ACL surgery, muscle stiffness was associated with muscle strength [43]. As seen in the previous studies, muscle stiffness can be interpreted as muscle spasms as well as muscle strength.…”

Section: Discussionmentioning

confidence: 91%

Does muscle stiffness predict early-onset knee osteoarthritis?

Gökşen¹,

Can²,

YILMAZ³

2021

Journal of Surgery and Medicine

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“…This is because the increased IMAT content in the skeletal muscle is inextricably linked to decreased muscle mass and strength in the T2DM population ( 50 ). Skeletal muscles are composed of contractile components (actin and myosin) and passive elastic components (connective tissue) ( 51 ). The amount of fat infiltrating the muscle may alter its components.…”

Section: Discussionmentioning

confidence: 99%

Application of conventional ultrasound coupled with shear wave elastography in the assessment of muscle strength in patients with type 2 diabetes

Chen,

Hu,

Liao

et al. 2024

Quant Imaging Med Surg

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Background In patients with type 2 diabetes mellitus (T2DM), a decrease in muscle function may be related to changes in the biomechanical properties of skeletal muscles. However, the correlations between muscle function and the characteristics of muscle size and stiffness as measured by ultrasound in patients with T2DM are unclear. The aim of this study was to investigate the abilities of conventional ultrasound and shear wave elastography (SWE) to assess muscle properties in patients with T2DM and to correlate the findings with isokinetic muscle testing and functional tests. Methods Sixty patients from the Department of Endocrinology in The Third Affiliated Hospital of Southern Medical University diagnosed with T2DM were recruited in this cross-sectional study from September 2021 to September 2022. T2DM was defined based on the American Diabetes Association criteria. The exclusion criteria were a history of injury or operation of the lower limb or clinical signs of neuromuscular disorders, any muscle-induced disease, and the presence of other types of diabetes mellitus. Thirty-five matched healthy volunteers were continuously included in the control group. SWE was used to measure the muscle stiffness of the quadriceps femoris [vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM), vastus intermedius (VI)] and the biceps brachii (BB) in a relaxed position, and the shear wave velocity (SWV) values were recorded. Muscle size was measured using conventional ultrasound. The participants underwent isokinetic knee extension/flexion (60°/sec) to assess muscle strength and functional tests of physical performance, including the short physical performance battery, 30-s chair stand test, timed up-and-go test, and 6-meter walk test. All demographics and measured variables were compared using the independent samples t -test. Interclass correlation coefficient analysis was performed on the measurement data obtained by the two operators, and Pearson correlation coefficients were used to determine the relationships between variables. Results Patients with T2DM exhibited worse physical performance (P<0.05) and weaker lower limb muscle strength (P<0.05) than did healthy controls, but their handgrip strength was comparable (P=0.102). Patients with T2DM had significantly decreased muscle thickness [RF thickness: 10.69±3.21 vs. 13.09±2.41 mm, mean difference =−2.40, 95% confidence interval (CI): −3.56 to −1.24, P<0.001; anterior quadriceps thickness: 23.45±7.11 vs. 27.25±5.25 mm, mean difference =−3.80, 95% CI: −6.33 to −1.26, P=0.004] and RF cross-sectional area (3.04±1.10 vs. 4.11±0.95 cm 2 , mean difference =−1.07, 95% CI: −1.49 to −0.64; P<0.001) compared to healthy controls. Smaller muscle size was associated with decreased muscle strength (r=0.44–0.69, all P values <0.001). Except for the BB (3.48±0.38 ...

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Decreased passive muscle stiffness of vastus medialis is associated with poorer quadriceps strength and knee function after anterior cruciate ligament reconstruction

Cited by 9 publications

References 57 publications

Effects of Deficits in the Neuromuscular and Mechanical Properties of the Quadriceps and Hamstrings on Single-Leg Hop Performance and Dynamic Knee Stability in Patients After Anterior Cruciate Ligament Reconstruction

Effects of Deficits in the Neuromuscular and Mechanical Properties of the Quadriceps and Hamstrings on Single-Leg Hop Performance and Dynamic Knee Stability in Patients After Anterior Cruciate Ligament Reconstruction

Does muscle stiffness predict early-onset knee osteoarthritis?

Application of conventional ultrasound coupled with shear wave elastography in the assessment of muscle strength in patients with type 2 diabetes

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