Quadriceps muscle dysfunction is common following anterior cruciate ligament reconstruction (ACLR). Data considering the diversity of neural changes, in-concert with morphological adaptations of the quadriceps muscle, are lacking. We investigated bilateral differences in neural and morphological characteristics of the quadriceps muscle in ACLR participants (n = 11, month post-surgery: 69.4 ± 22.4) compared to controls matched by sex, age, height, weight, limb dominance, and activity level. Spinal reflex excitability was assessed using Hoffmann reflexes (H:M); corticospinal excitability was quantified via active motor thresholds (AMT) and motor-evoked potentials (MEP) using transcranial magnetic stimulation. Cortical activation was assessed using a knee flexion/extension task with functional magnetic resonance imaging (fMRI). Muscle volume was quantified using structural MRI. Muscle strength and patient-reported outcomes were also collected. 2 × 2 RM ANOVAs were used to evaluate group differences. Smaller quadriceps muscle volume (total volume, rectus femoris, vastus medialis, and intermedius) and lower strength were detected compared to contralateral and control limbs. Individuals with ACLR reported higher levels of pain and fear and lower levels of knee function compared to controls. No differences were observed for H:M. ACLR individuals demonstrated higher AMT bilaterally and smaller MEPs in the injured limb, compared to the controls. ACLR participants demonstrated greater activation in frontal lobe areas responsible for motor and pain processing compared to controls, which were associated with self-reported pain. Our results suggest that individuals with ACLR demonstrate systemic neural differences compared to controls, which are observed concurrently with smaller quadriceps muscle volume, quadriceps muscle weakness, and self-reported dysfunction.
Functional magnetic resonance imaging Transcranial magnetic stimulation Muscle atrophy Cortical activation Quadriceps weakness
This is a preview of subscription content, log in to check access.
The authors would like to acknowledge Elisa Medeiros (MRI services manager, University of Connecticut’s Brain Imaging Research Center) for their assistance and support in MRI data collection and design. This research was supported by a Faculty Seed Grant from the University of Connecticut’s Brain Imaging Research Center (BIRC).
Chmielewski TL, Jones D, Day T, Tillman SM, Lentz TA, George SZ (2008) The association of pain and fear of movement/reinjury with function during anterior cruciate ligament reconstruction rehabilitation. J Orthop Sports Phys Therapy 38:746–753. https://doi.org/10.2519/jospt.2008.2887CrossRefGoogle Scholar
Flanigan DC, Everhart JS, Pedroza A, Smith T, Kaeding CC (2013) Fear of reinjury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg 29:1322–1329. https://doi.org/10.1016/j.arthro.2013.05.015CrossRefGoogle Scholar
Gumucio JP, Sugg KB, Sibilsky Enselman ER, Konja AC, Eckhardt LR, Bedi A, Mendias CL (2018) Anterior cruciate ligament tear induces a sustained loss of muscle fiber force production. Muscle Nerve. https://doi.org/10.1002/mus.26075Google Scholar
Harkey M, McLeod M, Terada M, Gribble P, Pietrosimone B (2015) Quadratic association between corticomotor and spinal-reflexive excitability and self-reported disability in participants with chronic ankle instability. J Sport Rehabil https://doi.org/10.1123/jsr.2014-0282Google Scholar
Heun R, Jessen F, Klose U, Erb M, Granath DO, Grodd W (2000) Response-related fMRI analysis during encoding and retrieval revealed differences in cerebral activation by retrieval success. Psychiatry Res 99:137–150CrossRefGoogle Scholar
Hopkins J, Ingersoll C, Krause B, Edwards J, Cordova M (2001a) Effect of knee joint effusion on quadriceps and soleus motoneuron pool excitability. Med Sci Sports Exerc 33:123–126CrossRefGoogle Scholar
Hopkins JT, Ingersoll CD, Krause BA, Edwards JE, Cordova ML (2001b) Effect of knee joint effusion on quadriceps and soleus motoneuron pool excitability. Med Sci Sport Exer 33:123–126CrossRefGoogle Scholar
Jenkinson M, Bannister P, Brady M, Smith S (2002) Improved optimization for the robust and accurate linear registration and motion correction of brain images. Neuroimage 17:825–841CrossRefGoogle Scholar
Livingston SC, Ingersoll CD (2008) Intra-rater reliability of a transcranial magnetic stimulation technique to obtain motor evoked potentials. Int J Neurosci 118:239–256CrossRefGoogle Scholar
Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152. https://doi.org/10.1002/art.20589CrossRefGoogle Scholar
Maden-Wilkinson TM, Degens H, Jones DA, McPhee JS (2013) Comparison of MRI and DXA to measure muscle size and age-related atrophy in thigh muscles. J Musculoskelet Neuronal Interact 13:320–328Google Scholar
Neuman P, Englund M, Kostogiannis I, Friden T, Roos H, Dahlberg LE (2008) Prevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study. Am J Sports Med 36:1717–1725. https://doi.org/10.1177/0363546508316770CrossRefGoogle Scholar
Norte GE, Pietrosimone BG, Hart JM, Hertel J, Ingersoll CD (2010) Relationship between transcranial magnetic stimulation and percutaneous electrical stimulation in determining the quadriceps central activation ratio. Am J Phys Med Rehabil 89:986–996CrossRefGoogle Scholar
Norte GE, Hertel JN, Saliba SA, Diduch DR, Hart JM (2018a) Quadriceps and patient-reported function in ACL-Reconstructed patients: a principal component analysis. J Sport Rehabil:1–9 https://doi.org/10.1123/jsr.2017-0080
Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE (2010) Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med 38:1968–1978. https://doi.org/10.1177/0363546510376053CrossRefGoogle Scholar
Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD (2016) Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. https://doi.org/10.1177/0363546515621554Google Scholar
Williams GN, Buchanan TS, Barrance PJ, Axe MJ, Snyder-Mackler L (2005a) Quadriceps weakness, atrophy, and activation failure in predicted noncopers after anterior cruciate ligament injury. Am J Sports Med 33:402–407CrossRefGoogle Scholar