Relative distribution of quadriceps head anatomical cross-sectional areas and volumes—Sensitivity to pain and to training intervention

Abstract

SUMMARY Introduction Quadriceps heads are important in biomechanical stabilization and in the pathogenesis osteoarthritis of the knee. This is the first study to explore the relative distribution of quadriceps head anatomical cross-sectional areas (ACSA) and volumes, and their response to pain and to training intervention. Methods The relative proportions of quadriceps heads were determined in 48 Osteoarthritis Initiative participants with unilateral pain (65% women; age 45–78y). Quadriceps head volumes were also measured in 35 untrained women (45–55y) before and after 12 week training intervention. Cross-sectional areas of the vastus medialis (VM), inter-medius (VIM), and lateralis (VL), and of the rectus femoris (RF) were determined from axial T1-weighted MR images. Results The proportion of the VM on the total quadriceps ACSA increased from proximal to distal. The difference in quadriceps ACSA of painful (vs. pain-free) limbs was −5.4% for the VM (p<0.001), −6.8% for the VL (p<0.01), −2.8% for the VIM (p=0.06), and +3.4% for the RF (p=0.67) but the VM/VL ratio was not significantly altered. The muscle volume increase during training intervention was +4.2% (p<0.05) for VM, +1.3% for VL, +2.0% for VIM (p<0.05) and +1.6% for RF. Conclusion The proportion of quadriceps head relative to total muscle ACSA and volume depends on the anatomical level studied. The results suggest that there may be a differential response of the quadriceps heads to pain-induced atrophy and to training-related hypertrophy. Studies in larger samples are needed to ascertain whether the observed differences in response to pain and training are statistically and clinically significant.

Longitudinal (4 year) change of thigh muscle and adipose tissue distribution in chronically painful vs painless knees – data from the Osteoarthritis Initiative

“…Because pain intensity varies based on body mass and physical activity 37 , findings may be different in a more sedentary cohort of subjects with KOA. Yet, our findings indicate that greater loss in muscle CSAs in chronically painful knees may occur specifically in the VM, this being in line with previous cross-sectional findings 12,23,38–43 . This finding, however, will have to be confirmed in future longitudinal studies in which the VM CSA being the primary analytic outcome.…”

“…We have shown previously that measurement of quadriceps CSAs is more sensitive to longitudinal change than isometric muscle strength 27 , and for this reason, we selected change in quadriceps CSA as the primary outcome of muscle status. Further, determination of muscle CSAs and quadriceps heads have shown to have excellent test-retest reliability 12,23 .…”

“…Using a signal intensity threshold IMF was separated from IMT 18 . Further, individual quadriceps heads (vastus medialis [VM], lateralis [VL], intermedius [VIM], and rectus femoris [RF]) were determined in an MRI slice located at 30% femoral length, because separation of the heads is more straight forward distally (Figure 2) 9,10,12,23 . All segmentations were done in baseline, year 2 and year 4 follow-up images by the same reader (A.R.…”

Intra- and inter-observer reliability of quantitative analysis of the infra-patellar fat pad and comparison between fat- and non-fat-suppressed imaging—Data from the osteoarthritis initiative

“…The intra-observer variability of quantitative measurements of thigh adipose tissue was 10.7% for subcutaneous fat, and 12.4% for intermuscular fat (Dannhauer et al, 2015) with a 2-year interval in between data acquisition. For comparison, the intra-observer variability of the vastus medialis anatomical muscle cross-sectional areas was reported to be 4.3/4.5% (painful/painless knees), with a 1-year interval in between data analysis (Sattler et al, 2014), and the intra-observer reliability of cartilage thickness and volume measurements in the knee was reported to range from 2.1 to 3.3% (Eckstein et al, 2008). The reliability values reported here are thus in the range of previously reported precision errors of other musculoskeletal tissues, for which imaging biomarkers have been developed.…”

Osteoarthritis year in review 2015: imaging

“…Quadriceps cross-sectional area reduced and intermuscular fat increased over 4 years, but these changes were not associated with chronic knee pain 40 . The proportion of quadriceps head relative to total muscle anatomical cross-sectional areas and volume depended on the anatomical level and responded differently to pain-induced atrophy and trainingrelated hypertrophy 41 .…”