Patellofemoral MRI Alterations Following Single Bundle ACL Reconstruction with Hamstring Autografts Are Associated with Quadriceps Femoris Atrophy

High incidence of patellofemoral pain and patellofemoral joint osteoarthritis was found following anterior cruciate ligament(ACL)reconstruction.The unstability of patellofemoral joint might be an important contribution factor.This study was designed to define the relationship between the unstability of patellofemoral joint and quadriceps femoris atrophy.Twenty patients underwent MRI scan before ACL reconstruction and every two weeks after surgery,until 12 weeks.The merchant’s patellar congruence angle,lateral inclination angle,and quadriceps femoris muscle cross-sectional area were measured and the relationship between the changes of angles and the ratio of quadriceps femoris atrophy was studied by multiple regression analysis.Significant quadriceps femoris atrophy was observed after ACL reconstruction during the follow-up period of 12 weeks.The merchant’s patellar congruence angle and lateral inclination angle significantly changed after surgery.The alterations of the merchant’s patellar congruence angle were significantly correlated with the atrophy ratio of vastus medialis(coefficient=-5.76)and vastus lateralis(coefficient=8.35)during the follow-up period of 12 weeks.The alterations of lateral inclination angle were significantly correlated with the atrophy ratio of vastus medialis(coefficient=20.62),vastus lateralis(coefficient=-11.38)and rectus femoris(coefficient=-0.469)during the follow-up period 12 weeks.To sum up,ACL reconstruction can alleviate the dysfunction of patellofemoral joint to a certain extent.But,the unbalanced atrophy of quadriceps femoris once again destroyed the stability of patellofemoral joint following the operation,which might be one cause of patellofemoral joint pain and early onset of osteoarthritis after ACL reconstruction.So,rehabilitation training that focuses on quadriceps femoris especially the vastus medialis shortly following operation is suggested.

Intermittent blood flow restriction does not reduce atrophy following anterior cruciate ligament reconstruction

Background:A previous study has reported a 50% reduction in disuse atrophy of the quadriceps during the first 14 days after anterior cruciate ligament(ACL) reconstruction.A follow-up trial is needed to confirm these promising results.The present study aims to investigate the effect of an occlusion stimulus on quadriceps atrophy after ACL reconstruction.Methods:A total of 24 subjects participated in the study.They were randomized into two groups.Starting the 2nd day after surgery,the occlusion group received an occlusion stimulus for 5 min,followed by removal of the occlusive pressure for 3 min.This was repeated five times in one training session,twice daily.During the period of occlusive stimulus,the subjects performed 20 low load exercises for the quadriceps.The control group followed the same exercise protocol,but without the occlusion stimulus.Changes in quadriceps anatomical cross section area(ACSA) were measured using axial magnetic resonance(MR) images at 40% and 50% of the length of the femur.Results:Both groups had a significant reduction of quadriceps ACSA from 2 days before surgery to 16 days after surgery.During the intervention period,the occlusion group lost 13.8% ± 1.1%(mean ± SEM) and the control group lost 13.1% ± 1.0% of their quadriceps ACSA,respectively.There was no significant difference between the occlusion and control groups with regards to atrophy of the quadriceps muscles.Conclusion:In conflict with other studies using a similar protocol,application of blood flow restriction the first 14 days after ACL reconstruction did not reduce quadriceps ACSA muscle atrophy measured by MR in a population of athletes.