Effect of Subcutaneous Tissue on Changes in Thigh Circumference Following Anterior Cruciate Ligament Reconstruction

Abstract

Circumference measurements have been used to estimate muscle cross-sectional area (CSA) in clinical settings. Measurements of thigh circumference are affected by muscle and subcutaneous fat (SF). In fact, SF could increase over a short period. Therefore, clarifying the relationship between thigh circumference and muscle and SF following ACL reconstruction is important. This study’s primary purpose was to examine pre- and post-operative changes in thigh circumference, thigh muscles and SF CSAs in both legs. Secondary, the relationship between thigh circumference and muscle and SF CSAs was examined to demonstrate that circumference measurements could be used to detect atrophy. Quadriceps, hamstrings, and SF CSAs at 15, 10, and 5 cm proximal to the patella were measured by MRI pre- and 4 weeks postoperatively to examine how reconstruction affected those tissues in the thighs. The results showed increases in SF CSA (r=0.72 at 10 cm, r=0.67 at 15 cm) greatly affected thigh circumference in females on the surgical side. In males, increases in SF CSA (r=0.83) at 15- and 5-cm and decreases in quadriceps muscle CSA (r=0.73) at 5 cm affected thigh circumference on the surgical side. Thigh circumference measurements might not reflect actual muscle CSA in ACL patients.

Key words

ACL reconstruction - thigh circumference - fat - MRI

• References

• 1 Chen B-B, Shih T, Hsu C-Y, Yu C-W, Wei S-Y, Chen C-Y, Wu C-H, Chen C-Y. Thigh muscle volume predicted by anthropometric measurements and correlated with physical function in the older adults. J Nutr Health Aging 2011; 15: 433-438
• 2 Ezaki C, Murata J, Miyazaki J, Horie J, Murata J, Otao H. Relationship between thigh circumference, quadriceps femoris thickness and quadriceps femoris muscle strength in community-dwelling elderly. . Rigakuryoho Kagaku 2010; 25: 673-676
• 3 Housh DJ, Housh TJ, Weir JP, Weir LL, Johnson GO, Stout JR. Anthropometric estimation of thigh muscle cross-sectional area. Med Sci Sports Exerc 1995; 27: 784-791
• 4 Yoshihiro K, Hidemi F, Shin M, Kazuto T, Jun M, Isao T. Relationships between lower limb circumferences and muscle strength and thickness. Rigakuryoho Kagaku 2008; 23: 785-788
• 5 Arangio GA, Chen C, Kalady M, Reed III JF. Thigh muscle size and strength after anterior cruciate ligament reconstruction and rehabilitation. J Orthop Sports Phys Ther 1997; 26: 238-243
• 6 Fukahori Y, Koga T, Soejima O, Cho K, Nomiyama H, Takeshita M, Takagishi N. Evaluation of the muscle strength of the knee joint and sport activities in the knee injured patients after operative treatment. Orthopedics & Traumatology 1991; 39: 1447-1450
• 7 Hasegawa S, Kobayashi M, Arai R, Tamaki A, Nakamura T, Moritani T. Effect of early implementation of electrical muscle stimulation to prevent muscle atrophy and weakness in patients after anterior cruciate ligament reconstruction. J Electromyogr Kinesiol 2011; 21: 622-630
• 8 Konishi Y, Ikeda K, Nishino A, Sunaga M, Aihara Y, Fukubayashi T. Relationship between quadriceps femoris muscle volume and muscle torque after anterior cruciate ligament repair. Scand J Med Sci Sports 2007; 17: 656-661
• 9 Snow BJ, Wilcox JJ, Burks RT, Greis PE. Evaluation of muscle size and fatty infiltration with MRI nine to eleven years following hamstring harvest for ACL reconstruction. J Bone Joint Surg Am 2012; 94: 1274-1282
• 10 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: 7-11
• 11 LoPRESTI C, Kirkendall DT, Street GM, Dudley Jr AW. Quadriceps insufficiency following repair of the anterior cruciate ligament. J Orthop Sports Phys Ther 1988; 9: 245-249
• 12 Noyes FR, Mangine RE, Barber S. Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med 1987; 15: 149-160
• 13 Nakayama Y, Shirai Y, Narita T, Mori A, Kobayashi K. Knee functions and a return to sports activity in competitive athletes following anterior cruciate ligament reconstruction. J Nippon Med Sch 2000; 67: 172-176
• 14 Sugimoto D, Heyworth BE, Collins SE, Fallon RT, Kocher MS, Micheli LJ. Comparison of lower extremity recovery after anterior cruciate ligament reconstruction with transphyseal hamstring versus extraphyseal iliotibial band techniques in skeletally immature athletes. Orthop J Sports Med 2018; 6: 2325967118768044
• 15 Hess T, Duchow J, Roland S, Kohn D. Single-versus two-incision technique in anterior cruciate ligament replacement: influence on postoperative muscle function. Am J Sports Med 2002; 30: 27-31
• 16 Nakamura E, Mizuta H, Kubota K, Shiraishi M, Kai K, Sakuma K, Takagi K. The atrophy and weakness of the thigh muscles after reconstruction of the anterior cruciate ligament. Orthopedics & Traumatology 1991; 40: 20-25
• 17 Harriss D, MacSween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 update. Int J Sports Med 2017; 38: 1126-1131
• 18 Fukunaga T, Miyatani M, Tachi M, Kouzaki M, Kawakami Y, Kanehisa H. Muscle volume is a major determinant of joint torque in humans. Acta Physiol Scand 2001; 172: 249-255
• 19 Walton J, Roberts N, Whitehouse G. Measurement of the quadriceps femoris muscle using magnetic resonance and ultrasound imaging. Br J Sports Med 1997; 31: 59-64
• 20 Welsman J, Armstrong N, Kirby B, Winsley R, Parsons G, Sharpe P. Exercise performance and magnetic resonance imaging-determined thigh muscle volume in children. Eur J Appl Physiol Occup Physiol 1997; 76: 92-97
• 21 Mukaka MM. A guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012; 24: 69-71
• 22 De Carlo MS, Shelbourne KD, McCarroll JR, Rettig AC. Traditional versus accelerated rehabilitation following ACL reconstruction: A one-year follow-up. J Orthop Sports Phys Ther 1992; 15: 309-316
• 23 Gerber JP, Marcus RL, Dibble LE, Greis PE, Burks RT, LaStayo PC. Effects of early progressive eccentric exercise on muscle structure after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2007; 89: 559-570
• 24 Shelbourne KD, Nitz P. Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 1990; 18: 292-299
• 25 Knapik JJ, Staab JS, Harman EA. Validity of an anthropometric estimate of thigh muscle cross-sectional area. Med Sci Sports Exerc 1996; 28: 1523-1530
• 26 Watanabe G. Observation of the body composition on the femoral plane by computed tomography method. Showa Igakkai Zasshi 1985; 45: 517-525
• 27 Choi JY, Ha JK, Kim YW, Shim JC, Yang SJ, Kim JG. Relationships among tendon regeneration on MRI, flexor strength, and functional performance after anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 2012; 40: 152-162
• 28 Rispoli DM, Sanders TG, Miller MD, Morrison WB. Magnetic resonance imaging at different time periods following hamstring harvest for anterior cruciate ligament reconstruction. Arthroscopy 2001; 17: 2-8
• 29 van der Made AD, Wieldraaijer T, Kerkhoffs G, Kleipool R, Engebretsen L, van Dijk C, Golanó P. The hamstring muscle complex. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2115-2122
• 30 Woodley SJ, Mercer SR. Hamstring muscles: Architecture and innervation. Cells Tissues Organs 2005; 179: 125-141
• 31 Nakamae A, Deie M, Yasumoto M, Adachi N, Kobayashi K, Yasunaga Y, Ochi M. Three-dimensional computed tomography imaging evidence of regeneration of the semitendinosus tendon harvested for anterior cruciate ligament reconstruction: A comparison with hamstring muscle strength. J Comput Assist Tomogr 2005; 29: 241-245
• 32 Maruyama Y, Iizuka S, Yoshida K. Ultrasonic observation on distribution of subcutaneous fat in Japanese young adults with reference to sexual difference. Ann Physiol Anthropol 1991; 10: 61-70
• 33 Kai Y, Fujino H, Murata S, Takei K, Murata J, Takeda I. Relationships among body composition, upper and lower limb muscle strength and circumference of the extremities. Rigakuryoho Kagaku 2008; 23: 241-244
• 34 Selkow NM, Pietrosimone BG, Saliba SA. Subcutaneous thigh fat assessment: a comparison of skinfold calipers and ultrasound imaging. J Athl Train 2011; 46: 50-54