Early Quadriceps Wasting after Anterior Cruciate Ligament Reconstruction in Young Adults: A Prospective Study

Abstract

Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the knee that requires surgical intervention. The weakness of quadriceps muscle is a sequele of ACL tear that can persist even after reconstruction. Muscle wasting if identified in early postoperative period can help to formulate structured protocols for rehabilitation that can help patient to recover. Best available method for scan of the same includes Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan, but it is neither accessible nor affordable to masses of population. Aim: To evaluate the quadriceps thickness using an easily available modality i.e., Ultrasonography (USG) and thigh circumference to detect early wasting. Materials and Methods: This prospective longitudinal study was done on 48 patients between the ages of 18-45 years with ACL tear operated arthroscopically. After six months of surgery, all patients were evaluated for quadriceps thickness using USG and thigh circumference using traditional measuring tape at the same points. Paired t-test was used for evaluation of the results. Results: This study quantifies quadriceps thickness using USG at two distinct levels of the thigh and found a significant deficit of 13.05% in the involved extremity at 1/3rd of femur length from knee joint and a deficit of 11.72% in involved extremity at 2/3rd of femur length from knee joint. This study established that the quadriceps of the involved extremity definitely goes under atrophy despite early rehabilitation. Also, there was a deficit of 5.04% in thigh circumference at 1/3rd of femur length from knee joint and 4.43% at 2/3rd of femur length from knee joint in the operated limb. There was no positive correlation between both the methods. Conclusion: This study concluded that USG is an easily available and affordable method to determine quadriceps thickness and it’s wasting early in the postoperative rehabilitation phase. It can assist in establishing early vigorous rehabilitation protocols. The traditional method of measuring thigh circumference using measuring tape to quantify quadriceps muscle bulk can be misleading as its underestimates the atrophy due to various factors.

Relationship between lower limb muscle strength and knee function with quality of life after anterior cruciate ligament reconstruction patients: a literature review

“…7 It is believed that changes in the frequency of activity of the quadriceps muscle, hamstring muscle, and both ends of the gastrocnemius muscle after ACLR due to changes in morphology and the nervous system are considered to be risk factors for such weakness. 8,9 Examination of knee function due to decreased quadriceps and hamstring muscle strength can use the KOOS (knee injury and osteoarthritis outcome score) questionnaire, which serves as an instrument to determine the condition of knee injuries that can be such as post-traumatic osteoarthritis (OA), meniscus, cartilage, and others. 10 The knee score measurement scale and KOOS can also use Lysholm, designed to measure outcomes after knee ligament surgery.…”