J Knee Surg 2021; 34(05): 533-537
DOI: 10.1055/s-0039-1697899
Original Article

The Effect of ACL Reconstruction on Involved and Contralateral Limb Vastus Lateralis Morphology and Histology: A Pilot Study

Eric C. Leszczynski
1   Department of Kinesiology, Michigan State University, East Lansing, Michigan
,
Christopher Kuenze
1   Department of Kinesiology, Michigan State University, East Lansing, Michigan
2   Division of Sports Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
,
Brett Brazier
2   Division of Sports Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
,
Joseph Visker
1   Department of Kinesiology, Michigan State University, East Lansing, Michigan
,
David P. Ferguson
1   Department of Kinesiology, Michigan State University, East Lansing, Michigan
› Author Affiliations
Funding None.

Abstract

Quadriceps muscle weakness is a commonly reported issue post anterior cruciate ligament reconstruction (ACLR), with minimal information related to skeletal muscle morphology following surgery. The purpose is to examine the morphological and functional differences in the vastus lateralis muscle from patient's ACLR and contralateral leg. Three physically active ACLR participants were recruited and secured to a dynamometer to perform maximal voluntary isometric knee extension contractions (MVIC) of the ACLR and contralateral limb. Muscle biopsies of the ACLR and contralateral vastus lateralis were performed, then sectioned, and stained for myosin isoforms to determine fiber type. Confocal images were acquired, and ImageJ software was used to determine the fiber type and cross-sectional area (CSA). There was a significant reduction in CSA of the type IIa and type IIx muscle fiber cells between healthy (IIa: 7,718 ± 1,295 µm2; IIx; 5,800 ± 601 µm2) and ACLR legs (IIa: 4,139 ± 709 µm2; IIx: 3,708 ± 618 µm2) (p < 0.05), while there was no significant difference in knee extension MVIC torque between legs (healthy limb: 2.42 ± 0.52 Nm/kg; ACLR limb: 2.05 ± 0.24 Nm/kg, p = 0.11). The reduction in the cross-sectional area of the ACLR type II fibers could impair function and increase secondary injury risk.

Authors’ Contributions

C.K. and D.P.F. were responsible for the study design and data collection while all authors were involved in the analysis and interpretation of the data presented. All authors were involved in drafting and reviewing the manuscript. All authors have read and approved the manuscript as submitted.




Publication History

Received: 29 March 2019

Accepted: 12 August 2019

Article published online:
30 September 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Mall NA, Chalmers PN, Moric M. et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 2014; 42 (10) 2363-2370
  • 2 Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2013; 41 (07) 1549-1558
  • 3 Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 2011; 45 (07) 596-606
  • 4 Palmieri-Smith RM, Lepley LK. Quadriceps strength asymmetry after anterior cruciate ligament reconstruction alters knee joint biomechanics and functional performance at time of return to activity. Am J Sports Med 2015; 43 (07) 1662-1669
  • 5 Lepley AS, Gribble PA, Thomas AC, Tevald MA, Sohn DH, Pietrosimone BG. Quadriceps neural alterations in anterior cruciate ligament reconstructed patients: a 6-month longitudinal investigation. Scand J Med Sci Sports 2015; 25 (06) 828-839
  • 6 Pamukoff DN, Pietrosimone B, Ryan ED. et al. Whole body vibration improves early rate of torque development in individuals with ACL reconstruction. J Strength Cond Res 2017; 31 (11) 2292-3000
  • 7 Lepley LK, Palmieri-Smith RM. Pre-operative quadriceps activation is related to post-operative activation, not strength, in patients post-ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24 (01) 236-246
  • 8 Lepley LK, Palmieri-Smith RM. Quadriceps strength, muscle activation failure, and patient-reported function at the time of return to activity in patients following anterior cruciate ligament reconstruction: a cross-sectional study. J Orthop Sports Phys Ther 2015; 45 (12) 1017-1025
  • 9 Kuenze CM, Hertel J, Weltman A, Diduch D, Saliba SA, Hart JM. Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train 2015; 50 (03) 303-312
  • 10 Lepley AS, Ericksen HM, Sohn DH, Pietrosimone BG. Contributions of neural excitability and voluntary activation to quadriceps muscle strength following anterior cruciate ligament reconstruction. Knee 2014; 21 (03) 736-742
  • 11 Pietrosimone BG, Lepley AS, Ericksen HM, Clements A, Sohn DH, Gribble PA. Neural excitability alterations after anterior cruciate ligament reconstruction. J Athl Train 2015; 50 (06) 665-674
  • 12 Ingersoll CD, Grindstaff TL, Pietrosimone BG, Hart JM. Neuromuscular consequences of anterior cruciate ligament injury. Clin Sports Med 2008; 27 (03) 383-404 , vii
  • 13 Noehren B, Andersen A, Hardy P. et al. Cellular and morphological alterations in the vastus lateralis muscle as the result of ACL injury and reconstruction. J Bone Joint Surg Am 2016; 98 (18) 1541-1547
  • 14 Hart JM, Kuenze CM, Pietrosimone BG, Ingersoll CD. Quadriceps function in anterior cruciate ligament-deficient knees exercising with transcutaneous electrical nerve stimulation and cryotherapy: a randomized controlled study. Clin Rehabil 2012; 26 (11) 974-981
  • 15 Bergstrom J. Percutaneous needle biopsy of skeletal muscle in physiological and clinical research. Scand J Clin Lab Invest 1975; 35 (07) 609-616
  • 16 Hughes MC, Ramos SV, Turnbull PC. et al. Mitochondrial bioenergetics and fiber type assessments in microbiopsy vs. Bergstrom percutaneous sampling of human skeletal muscle. Front Physiol 2015; 6 (360) 360
  • 17 Leszczynski EC, Visker JR, Ferguson DP. The effect of growth restriction on voluntary physical activity engagement in mice. Med Sci Sports Exerc 2019
  • 18 Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9 (07) 671-675
  • 19 Di Stasi SL, Logerstedt D, Gardinier ES, Snyder-Mackler L. Gait patterns differ between ACL-reconstructed athletes who pass return-to-sport criteria and those who fail. Am J Sports Med 2013; 41 (06) 1310-1318
  • 20 Konishi Y, Fukubayashi T. Relationship between muscle volume and muscle torque of the hamstrings after anterior cruciate ligament reconstruction. J Sci Med Sport 2010; 13 (01) 101-105
  • 21 Zhang LQ, Nuber GW, Bowen MK, Koh JL, Butler JP. Multiaxis muscle strength in ACL deficient and reconstructed knees: compensatory mechanism. Med Sci Sports Exerc 2002; 34 (01) 2-8
  • 22 Williams GN, Buchanan TS, Barrance PJ, Axe MJ, Snyder-Mackler L. Quadriceps weakness, atrophy, and activation failure in predicted noncopers after anterior cruciate ligament injury. Am J Sports Med 2005; 33 (03) 402-407
  • 23 Thomas AC, Wojtys EM, Brandon C, Palmieri-Smith RM. Muscle atrophy contributes to quadriceps weakness after anterior cruciate ligament reconstruction. J Sci Med Sport 2016; 19 (01) 7-11
  • 24 Bell DR, Pfeiffer KA, Cadmus-Bertram LA. et al. Objectively measured physical activity in patients after anterior cruciate ligament reconstruction. Am J Sports Med 2017; 45 (08) 1893-1900
  • 25 Roos PE, Button K, van Deursen RW. Motor control strategies during double leg squat following anterior cruciate ligament rupture and reconstruction: an observational study. J Neuroeng Rehabil 2014; 11 (19) 19
  • 26 Gokeler A, Schmalz T, Knopf E, Freiwald J, Blumentritt S. The relationship between isokinetic quadriceps strength and laxity on gait analysis parameters in anterior cruciate ligament reconstructed knees. Knee Surg Sports Traumatol Arthrosc 2003; 11 (06) 372-378
  • 27 Gardinier ES, Manal K, Buchanan TS. et al. Gait and neuromuscular asymmetries after acute ACL rupture. Med Sci Sports Exerc 2012; 44 (08) 1490-1496
  • 28 Xergia SA, Pappas E, Zampeli F, Georgiou S, Georgoulis AD. Asymmetries in functional hop tests, lower extremity kinematics, and isokinetic strength persist 6 to 9 months following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2013; 43 (03) 154-162
  • 29 Elmqvist LG, Lorentzon R, Johansson C, Fugl-Meyer AR. Does a torn anterior cruciate ligament lead to change in the central nervous drive of the knee extensors?. Eur J Appl Physiol Occup Physiol 1988; 58 (1-2): 203-207
  • 30 Lorentzon R, Elmqvist LG, Sjöström M, Fagerlund M, Fuglmeyer AR. Thigh musculature in relation to chronic anterior cruciate ligament tear: muscle size, morphology, and mechanical output before reconstruction. Am J Sports Med 1989; 17 (03) 423-429
  • 31 Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ. Contralateral limb strength deficits after anterior cruciate ligament reconstruction using a hamstring tendon graft. Clin Biomech (Bristol, Avon) 2007; 22 (05) 543-550