title: Quadriceps function relates to muscle size following ACL reconstruction.
abstract: It remains unclear what role reduced volume and cross-section area (CSA) of individual quadriceps muscles may play in persistent quadriceps weakness and more global dysfunction following ACL reconstruction (ACLR). The purpose of this investigation was to establish the relationship between cross-sectional area of the quadriceps muscle group and measures of knee related and quadriceps function following ACLR. Thirty participants with a history of primary, unilateral ACLR experiencing persistent quadriceps activation failure participated in this cohort study. Clinical factors including International Knee Documentation Committee (IKDC) score, normalized knee extension MVIC torque (Nm/kg) and quadriceps central activation ratio (CAR, %) were assessed in addition to CSA. Quadriceps CSA was measured via magnetic resonance imaging (MRI; Siemens Avanto 1.5T). Quadriceps CSA (cm(2) ) and quadriceps volume (cm(3) ) as well as individual muscle estimates were identified within a 10 cm mid-thigh capture area. Pearson's product-moment correlation coefficients (r) established relationships between CSA and all other variables. Stepwise linear regression established which CSA factors were able to successfully predict clinical factors. Knee extension MVIC torque was strongly correlated with Vastus Intermedius (VI; r =  0.857, p < 0.001) CSA as well as partial VI (r = 0.849, p < 0.001) and quadriceps (r = 0.830, p < 0.001) volume. Partial VI (r = 0.365, p = 0.047) volume was weakly correlated with IKDC score. Knee extension MVIC torque was strongly predicted using VI CSA alone (R(2)  = 0.725) or in combination with Vastus Medialis CSA (VM; R(2)  = 0.756). Statement of Clinical Significance: Atrophy of the VI and VM muscles negatively impacts knee extension strength following ACLR. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1656-1662, 2016.
authors.affiliation: Department of Kinesiology, Michigan State University, East Lansing, Michigan.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kuenze
authors.affiliation: Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Blemker
authors.affiliation: Department of Human Services, Kinesiology Program Area, University of Virginia, Charlottesville, Virginia.|Department of Orthopaedic Surgery, Sports Medicine Division, University of Virginia, Charlottesville, Virginia.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Hart
mesh_terms: D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D011184:Postoperative Period; D052097:Quadriceps Muscle / Q000000981:diagnostic imaging / Q000502:physiology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: cross sectional area; knee extension torque; quadriceps central activation ratio