Background: Quadriceps tendon (QT) autografts are being increasingly used for anterior cruciate ligament reconstruction (ACLR). A paucity of studies exist that compare QT autografts with alternative graft options. Additionally, concerns exist regarding quadriceps recovery after graft harvest insult to the quadriceps muscle-tendon unit. Purpose/Hypothesis: The purpose of this study was to compare quadriceps recovery and functional outcomes in patients with QT versus bone–patellar tendon–bone (BPTB) autografts. The hypothesis was that those with QT autografts would demonstrate superior outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Active patients with a history of primary, unilateral ACLR with soft tissue QT or BPTB autografts participated. Quadriceps recovery was quantified using variables of strength, muscle size, and activation. Knee extensor isometric and isokinetic strength was measured bilaterally with an isokinetic dynamometer and normalized to body weight. Quadriceps activation was measured with the superimposed burst technique. The maximal cross-sectional area of each quadriceps muscle was measured bilaterally using magnetic resonance imaging. Assessors of muscle size were blinded to the graft type and side of ACLR. Functional tests included hop tests and step length symmetry during walking, measured via spatiotemporal gait analysis. Self-reported function was determined with the International Knee Documentation Committee (IKDC) questionnaire. Neuromuscular and functional outcomes were expressed as limb symmetry indices (LSIs: [surgical limb/nonsurgical limb]*100%). Wilcoxon rank-sum tests were used to compare the LSIs and IKDC scores between groups. Results: There were 30 study participants (19 male, 11 female; median age, 22 years [range, 14-41 years]; median time since surgery, 8 months [range, 6-23 months]), with 15 patients in each group. There were no significant between-group differences in demographic variables or outcomes. LSIs were not significantly different between the QT versus BPTB group, respectively: knee extensor isokinetic strength at 60 deg/s (median, 70 [range, 41-120] vs 68 [range, 37-83]; P = .285), activation (median, 95 [range, 85-111] vs 92 [range, 82-105]; P = .148), cross-sectional area of the vastus medialis (median, 79 [range, 62-104] vs 77 [range, 62-95]; P = .425), single-leg hop test (median, 88 [range, 35-114] vs 77 [range, 49-100]; P = .156), and step length symmetry (median, 99 [range, 93-104] vs 98 [range, 92-103]; P = .653). The median IKDC scores between the QT and BPTB groups were also not significantly different: 82 (range, 67-94) versus 83 (range, 54-94); respectively ( P = .683). Conclusion: Patients with QT autografts demons...

Background Despite extensive study of the impact of stroke on muscle and functional performance, questions remain regarding the extent to which changes are due to the neurological injury vs. age-related loss of morphology and force production. Objectives To synthesize available evidence describing post-stroke changes in lower extremity muscle size and strength compared to healthy adults. Methods Scientific literature was searched up to April 2016 to identify studies that included lower extremity muscle size and strength measures in individuals with chronic stroke. Lower extremity muscle size and strength data from healthy controls were sought for comparison. Relative differences were calculated between paretic, nonparetic, and control limbs. Results Fifteen studies with 375 participants (61% male; age = 62 ± 5 years; time since stroke = 60 ± 42 months) were included. The paretic limb exhibited deficits of ~13% in thigh muscle size, ~5% in lower leg muscle size, and ~8% in lean leg mass compared to the nonparetic limb. Paretic plantarflexor and knee extensor strength were 52 and 36% lower, respectively, compared to the nonparetic limb. When compared to age-matched control data, both paretic and nonparetic limbs showed deficits in muscle size and strength. Conclusions Age-related differences support the impact of stroke-related sarcopenia as a contributor to hemiparetic muscle dysfunction. Understanding these muscular changes is necessary for designing appropriate exercise interventions aimed at restoring muscle function.

Purpose The all-soft tissue quadriceps tendon (QT) autograft is becoming increasingly popular for ACL reconstruction (ACLR); however, studies reporting strength recovery and early outcomes after QT autograft are limited with patient samples composed of predominantly males. The primary purpose was to characterize early, sex-specific recovery of strength, range of motion (ROM), and knee laxity in a large cohort of patients undergoing primary ACLR with standardized harvest technique of the all-soft tissue QT autograft. The secondary purpose was to examine the influence of demographic factors and clinical measures on 6-month quadriceps strength. Methods Patients 14-25 years who underwent primary, unilateral ACLR with all-soft tissue QT autografts were prospectively followed. Knee laxity and ROM were collected at 6 weeks, 3 and 6 months; while, quadriceps normalized torques and limb symmetry indices (LSI) were collected at 3 and 6 months using isokinetic dynamometry at 60°/s. Two-way ANOVAs with repeated measures were conducted to determine recovery over time and between sexes. Stepwise linear multiple regressions were conducted to determine predictors of 6-month quadriceps strength. Results Three-hundred and twenty patients were included (18 ± 3 years; 156 males:164 females; BMI = 24 ± 4 kg/m 2 ) with no early graft failures within the study period. For strength, there were significant main effects of time (p < 0.001) and sex (p < 0.001), indicating similar improvement from 3 to 6 months with males demonstrating greater quadriceps LSI (6 months: 72.1 vs 63.3%) and normalized strength (6 months: 2.0 vs 1.6 Nm/kg). A significantly higher proportion of females had knee extension ROM deficits ≥ 5° compared to males at 6 weeks (61 vs 39%; p = 0.002). Female sex and 3-month extension ROM deficits were identified as significant predictors of 6-month quadriceps LSI (R 2 = 0.083; p < 0.001). Female sex, BMI, and 6-week extension ROM deficits were identified as significant predictors of 6-month normalized quadriceps strength (R 2 = 0.190; p < 0.001). Conclusions Females had decreased quadriceps strength and greater extension ROM deficits at 3 and 6 months following ACLR using all-soft tissue QT autografts. Female sex, higher BMI, and loss of extension ROM were independent predictors of poorer quadriceps strength at 6 months. There were no early graft failures, and laxity remained within normal ranges for both males and females. Surgeons and rehabilitation clinicians should be aware of the increased risk of postoperative loss of extension ROM in females and its implications on quadriceps strength recovery. Level of evidence III.

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Context Persistent neuromuscular deficits in the surgical limb after anterior cruciate ligament reconstruction (ACLR) have been repeatedly described in the literature, yet little is known regarding their association with physical performance and patient-reported function. Objective To describe (1) interlimb differences in neuromuscular and functional outcomes and (2) the associations of neuromuscular outcomes with measures of physical and knee-related patient-reported function. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants Thirty individuals after primary, unilateral ACLR (19 males; age = 21.5 years [range, 14–41 years]; 8 months [range = 6–23 months] postsurgery). Main Outcome Measure(s) Knee-extensor isometric and isokinetic peak torque was measured with an isokinetic dynamometer. Cross-sectional area (CSA) was measured bilaterally for each of the quadriceps muscles via magnetic resonance imaging. We measured quadriceps central activation bilaterally via the superimposed-burst technique. Physical performance (single-legged hop tests, step length via spatiotemporal gait analysis) and patient-reported outcomes (International Knee Documentation Committee questionnaire and Knee Injury and Osteoarthritis Outcome Score Sport and Recreation subscale) were also recorded. We conducted Wilcoxon signed rank tests to identify interlimb differences. Spearman ρ correlation analyses revealed associations between limb symmetry and neuromuscular and functional outcomes, as well as with patient-reported function. Results Deficits in the surgical limb as compared with the nonsurgical limb were present for all outcomes (P values &lt; .05). Greater single-legged hop-test symmetry (83%) was significantly correlated with greater symmetry in knee-extensor isometric (63%; rs = 0.567, P = .002) and isokinetic (68%; rs = 0.540, P = .003) strength, as well as greater cross-sectional area of the vastus medialis (78%; rs = 0.519, P = .006) and vastus lateralis (82%; rs = 0.752, P &lt; .001). A higher International Knee Documentation Committee questionnaire score (82.2) was significantly correlated with greater symmetry in knee-extensor isokinetic strength (rs = 0.379, P = .039). Conclusions Although deficits were observed in the surgical limb for all neuromuscular measures, greater symmetry in the size and strength of the quadriceps, rather than activation, was more strongly associated with physical performance after ACLR. Greater symmetry in strength was also more strongly associated with patient-reported function.

LH and FSH play critical roles in mammalian reproduction by mediating steroidogenesis and gametogenesis in the gonad. Gonadal steroid hormone feedback to the hypothalamus and pituitary influences production of the gonadotropins. We previously demonstrated that progesterone differentially regulates the expression of the LH and FSH beta-subunits at the level of the gonadotrope: FSHbeta transcription is induced, whereas LHbeta is repressed. In this study, we investigated the mechanism of progesterone repression of LHbeta gene expression using immortalized gonadotrope-derived LbetaT2 cells. The progesterone suppression of both basal and GnRH-induced LHbeta gene expression occurs in a hormone- and receptor-dependent manner. Chromatin immunoprecipitation demonstrates that the hormone-bound progesterone receptor (PR) is recruited to the endogenous mouse LHbeta promoter. In addition, suppression requires both the amino-terminal and DNA-binding regions of PR. Furthermore, progesterone suppression does not require direct PR binding to the promoter, and, thus, PR is likely recruited to the promoter via indirect binding through other transcription factors. These data demonstrate that the molecular mechanism for progesterone action on the LHbeta promoter is distinct from FSHbeta, which involves direct PR binding to the promoter to produce activation. It also differs from androgen repression of LHbeta gene expression in that, rather than Sp1 or steroidogenic factor-1 elements, it requires elements within -300/-250 and -200/-150 that also contribute to basal expression of the LHbeta promoter. Altogether, our data indicate that progesterone feedback at the level of the pituitary gonadotrope is likely to play a key role in differential production of the gonadotropin genes.

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