Quadriceps Muscle Size Following ACL Injury and Reconstruction: A Systematic Review

Abstract

Image‐based assessments of quadriceps muscle size facilitate examination of structural changes after anterior cruciate ligament (ACL) injury and reconstruction (ACLR). Understanding the effects of ACLR on muscle size measures may aid in clarifying the contribution of quadriceps atrophy toward quadriceps strength. The purpose of this study was to systematically review the literature examining the effects of ACLR on quadriceps muscle volume and cross‐sectional area (CSA). An online database search was conducted using Web of Science, SportDISCUS, PubMed (Medline), CINHAL (EBSCO), and Cochrane Library limited to articles published after January 1, 1980. Means and standard deviations were extracted for the ACLR limb and the contralateral limb, and sample characteristics from relevant articles. Magnitude of between limb differences were assessed using pooled effect sizes (Hedge's g) and 95% confidence intervals. Eleven articles (five CSA, six muscle volume) were included in this systematic review. Included studies reported negative effective sizes, indicating that the ACLR limb was smaller in CSA or muscle volume compared with the contralateral limb; however, 36% of the included articles reported meaningful difference between the limbs. Quadriceps atrophy may occur following ACL injury and persist after rehabilitation, however, the magnitude of these reductions may not be clinically meaningful and may only partially explain the persistent quadriceps weakness that is ubiquitous among this patient population. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:598–608, 2020

Contractile rate of force development after anterior cruciate ligament reconstruction—a comprehensive review and meta‐analysis

“…Gumucio et al 75 obtained vastus lateralis muscle biopsies 1, 2, and 6 months after ACLR, which revealed that individual myofibers had impaired intrinsic force generation capacity as reflected by reduced specific tension (force/CSA). Given that muscle volume and cross-sectional area, and muscle fascicle pennation angle influence maximal muscle force generation capacity, 18,19 it is likely that these morphological changes contribute to the RFD deficits described here in the knee extensor 90 and knee flexor 82,88,89,94,[96][97][98] muscles after ACLR.…”

“…Studies have described reduced knee extensor muscle volume and cross-sectional area following ACLR compared to the uninjured side 90 and to healthy controls. 91 Similar findings have been described for the knee flexor muscles when compared to the uninjured side [92][93][94][95][96][97][98] and uninjured controls.…”

Validity of ultrasonography derived predictions for estimating skeletal muscle volume- A systematic literature review

“…In the field of sport medicine, quadriceps MV partly explains persistent weakness after ACL injury (46) and atrophy of the quadriceps muscles negatively impacts knee extension strength (12). A valid measure of MV could be applied to monitor progress after ACL reconstruction and assist in return-to-play decisions by giving clinicians a quick and simple prediction of the athletes MV.…”

Gene expression changes in vastus lateralis muscle after different strength training regimes during rehabilitation following anterior cruciate ligament reconstruction

“…Even with guided rehabilitation, atrophy and strength deficits of the quadriceps femoris muscle were reported up to one year after ACL surgery [ 1 – 3 ] and even longer in subjects with chronically insufficient ACL [ 4 ]. Prolonged quadriceps weakness could only partially be explained by rather small reductions in quadriceps muscle mass indicating a discrepancy between the regain in quadriceps muscle mass and quadriceps strength [ 2 , 5 , 6 ]. This discrepancy might partly be due to impaired neuromuscular function, which is observed after ACL injury [ 7 , 8 ].…”