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International audience; Purpose: No therapeutic consensus has been established about proximal ruptures of the rectus femoris muscle. The objective of this literature review is to determine a therapeutic course of action. Methods: We conducted a literature review on the PubMed database using the following keywords (in French and English, respectively): "quadriceps/quadriceps", "droit ant erieur/rectus femoris", "proximal/ proximal", "chirurgie/surgical", "avulsion/avulsion". We collected 266 articles, 36 of them were selected, which were related to our topic: proximal rupture of the anterior rectus femoris. Patients with a proximal rupture of the rectus femoris, minor or major patient of traumatic origin were included in this study. Patients injured at another lesion level, or non-traumatic lesions of the proximal rectus femoris (tendinitis without ruptures, tumor or others) were excluded. For each patient, the indications, the type of treatment and the functional result were analyzed, with the time to recovery and the level of recovery from sports and professional activities (same sport/profession or not, same level or not) as the main criterion of judgment. Fisher exact test was used for statistical comparison. Results: The aims of conservative treatment are to be pain free for the patient, to fight hematoma and to rehabilitate the injury as quickly as possible. The surgical techniques are varied, with most consisting of either a reinsertion of the musculo-tendon stump or a resection of the scar tissue with myo-tendinoaponeurotic suture in place. The functional results are good for the majority of the treatments proposed, but the conservative treatment has a shorter recovery time (3 months vs. 4 months for the best surgical results). Highly displaced bone avulsion is the only indication for first-line surgical treatment. Conclusion: The main disadvantage of conservative treatment is the risk of residual pain beyond 3 months (10%), justifying an MRI to guide secondary surgical treatment. We propose a treatment plan for proximal rupture of the proximal rectus femoris rupture.

Objective To describe the injury mechanism and its association with magnetic resonance imaging (MRI) injury findings in acute rectus femoris injuries. Design Combined retrospective and prospective descriptive injury study. Retrospective cohort from January 2010 to October 2013 and prospective cohort from October 2013 to January 2019. Setting Specialized sports medicine hospital. Participants Male professional football players older than 18 years playing in a national football league, referred for injury assessment within 7 days after an acute rectus femoris injury, with a positive finding on MRI. Independent variables Rectus femoris muscle injury MRI findings in relation to injury mechanism in male football players. Main outcome measures Rectus femoris injury mechanism (kicking, sprinting, and others), MRI injury location, and grade. Results There were 105 injuries in total, with 60 (57.1%) and 45 (42.8%) injuries from the retrospective and prospective cohorts, respectively. Kicking was the injury mechanism in 57 (54.3%) of all acute rectus femoris injuries, sprinting represented 32 (30.4%), and 16 (15.2%) were classified as others. There were 20 (19.05%) free tendon, 67 (63.8%) myotendinous junction and/or intramuscular tendon, and 18 (17.1%) peripheral myofascial located injuries. All free tendon injuries were related to kicking and graded as a complete tear of at least one of the tendons in 15/20 (75.0%) cases. Conclusions Kicking seems to be an important mechanism related to complete ruptures and injuries occurring at the proximal free tendon. Sprinting was the other most common mechanism but was never associated with injury to the proximal free tendon.

Background Motor symptoms of spinal cord injury (SCI) considerably impair quality of life and are associated with a high risk of secondary diseases. So far, no pharmacological treatment is available for these symptoms. Therefore, we conducted a randomized, double‐blinded, placebo‐controlled study in dogs with spontaneous SCI due to disc herniation to test whether a reduction of spinal inhibitory activity by intramuscular injections of tetanus neurotoxin (TeNT) alleviates motor symptoms such as muscle atrophy or gait function. Methods To this end, 25 dogs were treated with injections of either TeNT or placebo into their paretic hindlimb muscles. Effects of TeNT on muscle thickness were assessed by ultrasound, while effects on gait function were measured using the modified functional scoring system in dogs. Results Four weeks after the TeNT injections, muscle thickness of the gluteus medius muscle (before median 1.56 cm [inter‐quartile range {IQR} 1.34–1.71 cm] and after median 1.56 cm [IQR 1.37–1.85 cm], P‐value 0.0133) as well as of the rectus femoris muscle (before median 0.76 cm [IQR 0.60–0.98 cm] and after median 0.93 cm [IQR 0.65–1.05 cm], P‐value 0.0033) significantly increased in the TeNT group. However, there was no difference in gait function between the TeNT and placebo groups. The treatment was well tolerated by all dogs without any signs of generalized tetanus symptoms or any spreading of effects beyond the lumbar level of the injected hindlimbs. Conclusions With regard to the beneficial effects on muscle thickness, intramuscular injections of TeNT represent the first pharmacological approach that focally reverses muscle atrophy in SCI. Moreover, the study data support the safety of this treatment when TeNT is used at low dose.

Background & aims: Muscle mass is an important biomarker of survival from a critical illness; however, there is no widely accepted method for routine assessment of low muscularity at intensive care unit (ICU) admission. We hypothesize that ultrasound-based partial muscle mass assessments can reflect the trunk muscle mass. Therefore, we aimed to investigate whether ultrasound muscle mass measurements could reflect trunk muscle mass and identify patients with low muscularity. Methods: We performed a retrospective analysis of prospectively obtained ultrasound data at ICU admission. We included patients who underwent computed tomography (CT) imaging at the third lumbar vertebra (L3) within 2 days before and 2 days after ICU admission. Primary outcomes included the correlation between the femoral muscle mass measurements using ultrasound and the cross-sectional area (CSA) at L3 obtained by CT. Low muscularity was defined as a skeletal muscle index of 36.0 cm2/m2 for males and 29.0 cm2/m2 for females. Secondary outcomes included the correlation with the ultrasound measurements of the biceps brachii muscle mass and diaphragm thickness. Results: Among 133 patients, 89 underwent CT imaging, which included the L3. The patient mean age was 72 ± 13 years, and 60 patients (67%) were male. The correlation between the femoral muscle ultrasound and CT was ρ = 0.57 (p < 0.01, n = 89) and ρ = 0.48 (p < 0.01, n = 89) for quadriceps muscle layer thickness and rectus femoris muscle CSA, and these had the discriminative power to assess low muscularity, with the areas under the curve of 0.84 and 0.76, respectively. The ultrasound measurements of the biceps brachii muscle mass and diaphragm thickness were correlated with CT imaging [ρ = 0.57–0.60 (p < 0.01, n = 52) and ρ = 0.35 (p < 0.01, n = 79)]. Conclusions: Ultrasound measurements of muscle mass were correlated with CT measurements, and the measurements of femoral muscle mass were useful to assess low muscularity at ICU admission.

This study was planned to determine the muscle architecture (pennation angle, muscle fiber length, and muscle thickness) and its relationship to lower extremity muscle strength in patients with Multiple Sclerosis (pwMS). The muscle architecture (pennation angle, muscle fiber length, and muscle thickness) and lower extremity muscle strength were assessed in 33 pwMS [13 Relapsing–Remitting MS (RRMS), 5 Primary Progressive MS (PPMS), 5 Secondary Progressive MS (SPMS), and 11 matched healthy controls (HC)]. Muscle architecture features were assessed with ultrasonography and muscle strength were assessed with a digital hand-held dynamometer. The rectus femoris muscle thickness and pennation angle, gastrocnemius muscle thickness, and the tibialis anterior pennation angle were significantly lower in pwMS compared to HC (p

This study aimed to examine the effects of age on hip flexion maximal and rapid strength and rectus femoris (RF) muscle size and composition in men. Fifteen young (25 [3] y) and 15 older (73 [4] y) men performed isometric hip flexion contractions to examine peak torque and absolute and normalized rate of torque development (RTD) at time intervals of 0 to 100 and 100 to 200 milliseconds. Ultrasonography was used to examine RF muscle cross-sectional area and echo intensity. Peak torque, absolute RTD at 0 to 100 milliseconds, and absolute and normalized RTD at 100 to 200 milliseconds were significantly lower (P = .004–.045) in the old compared with the young men. The older men exhibited lower cross-sectional area (P = .015) and higher echo intensity (P = .007) than the young men. Moreover, there were positive relationships between cross-sectional area and absolute RTD at 0 to 100 milliseconds (r = .400) and absolute RTD at 100 to 200 milliseconds (r = .450) and negative relationships between echo intensity and absolute RTD at 100 to 200 milliseconds (r = −.457) and normalized RTD at 100 to 200 milliseconds (r = −.373). These findings indicate that hip flexion maximal and rapid strength and RF muscle size and composition decrease in old age. The relationships observed between ultrasound-derived RF parameters and measurements of RTD suggest that these age-related declines in muscle size and composition may be relevant to hip flexion rapid torque production.

Background: Little is known about how chronic unilateral anterior knee pain (AKP) affects bilateral quadriceps function and lower quarter flexibility. Objective: To determine if patients with chronic unilateral AKP present bilateral deficits in quadriceps function and lower quarter flexibility. Methods: Twenty-two patients with chronic unilateral AKP (pain duration: 48.6 months) and 22 matched healthy controls were evaluated. Pain perception and functional outcomes were obtained. Knee joint and thigh circumferences, quadriceps subcutaneous tissue thickness and function (i.e. maximal and explosive strength, activation, and endurance), and lower quarter flexibility (i.e. hamstrings and iliopsoas/rectus femoris muscle) in both legs were compared across conditions. Results: Knee joint and thigh circumferences, and quadriceps subcutaneous tissue thickness were not different between conditions (P ≥ .39). Compared with matched healthy controls, patients with chronic unilateral AKP showed: 1) greater pain perception (0.0 versus 4.4 cm, P < .0001); 2) a lower score for functional outcomes (79.6 versus 53.9, P < .0001); 3) less bilateral quadriceps maximal (3.5 versus 2.8 Nm/kg, P < .0001) and explosive (10.8 versus 8.7 Nm/kg/s, P = .01) strength, activation (0.95 versus 0.83, P < .0001), and endurance (1.66 versus 1.52 Nm/kg, P = .02); and 4) less bilateral hamstrings (86.8 versus 72.6°, P = .002) and iliopsoas/rectus femoris (11.6 versus 7.8°, P < .05) flexibility. Conclusion: Patients with chronic unilateral AKP (without knee joint effusion or quadriceps muscle atrophy) appear to have bilateral deficits in quadriceps function and lower quarter flexibility, which should be addressed with pain reduction.

The main purpose of the present study was to investigate maturation-related changes in force-related factors in gymnasts and untrained girls. A total of 60 female participants were divided into two groups of gymnasts and untrained individuals. Each group had three subgroups of preadolescents, adolescents, and adults according to Tanner's scale. Informed consent forms were obtained from each participant. After familiarity and initial measurements, each subject performed three maximal voluntary isometric contractions (MVIC) of the knee extensors at five different angles to determine the optimal angle of force production. The rate of force development (RFD) was calculated using the torque data. The EMG signal of the rectus femoris muscle was recorded during the MVIC test to measure voluntary activation (RMS). Gymnasts had more absolute torque in all three age groups (P

Verletzungen der Oberschenkelmuskulatur gehoren zu den haufigsten Sportverletzungen. Beispielsweise beim Fusball machen sie nahezu 30 % aller Verletzungen aus. Insbesondere der M. rectus femoris ist aufgrund seiner anatomischen Besonderheiten exponiert. Wahrend die distalen Rupturen die Quadrizepssehne betreffen und nicht nur im Sport zu den haufigeren Verletzungen gehoren, stellen die proximalen Rupturen eine Seltenheit dar. Aufgrund der meist indifferenten klinischen Zeichen werden diese oft verspatet diagnostiziert. Klassifikationen zur Einteilung von Muskelverletzungen sind in verschiedenen Versionen in der Literatur beschrieben. In Bezug auf den M. rectus femoris existiert bisher keine Einteilung, aus der ein Therapieentscheid oder ein Algorithmus abgeleitet werden kann. Problematisch ist nicht nur die unklare Einteilung der Verletzung, sondern auch die daraus resultierende Variabilitat der Therapie. Selektive Literaturrecherche zur Erstellung einer Ubersichtsarbeit. Es gibt bisher keine standardisierte Nachbehandlung nach operativem Eingriff oder ein etabliertes Schema fur die konservative Therapie. Der Vergleich der einzelnen Studien untereinander ist aufgrund geringer Fallzahl und uneinheitlicher Klassifikation erschwert. Ein valider Behandlungsalgorithmus kann auf der Basis der aktuellen Datenlage nur schwer abgeleitet werden.

Background: Muscle wasting is a frequent finding in critically ill patients and is associated with worse short- and long term outcomes. Loss of mass and function of skeletal muscles starts early - in the first 24 hours after admission to Intensive Care Unit (ICU) - and may persist for years ‘Post-ICU syndrome’. Ultrasound of rectus femoris muscle is a valid and simple technique that could be used for longitudinal assessment of treatment success and facilitates the use of postoperative interventions that help in problems related to critical illness. The aim of this study is to evaluate sarcopenia by ultrasound of rectus femoris muscle as a predictor of outcomes of surgical intensive care unit. Materials and Methods: This prospective observational study was performed on 40 patients admitted to the surgical ICU, Tanta University Hospitals, Egypt, after approval of the Institutional Ethical Committee, Tanta University. The study started from April 2019 till January 2020. An informed consent was taken from the nearest relatives of the patients. All data of the patients was confidential with secret codes and private files for each patient. All given data was used for the current medical research only. Any unexpected risks appeared during the course of the research were cleared to the participants and ethical committee at time. Results: Cross-sectional area of rectus femoris muscle decreased significantly at all-time measurements as compared to the baseline at day 0 (within 24 hours from SICU admission), 5, 10, 15, 20, 25 and 30. There were negative correlations between delta cross-sectional area of rectus femoris muscle and age, height, weight, Body Mass Index and baseline cross-sectional area of rectus femoris muscle. There was a positive correlation between delta cross-sectional area of rectus femoris muscle and duration of mechanical ventilation, ICU length of stay and mortality. Conclusion: Rectus femoris cross-sectional area measured by B-mode ultrasonography showed significant role in nutritional assessment as it decreases in critically ill patients with positive correlation with duration of mechanical ventilation and ICU stay.

Background The aim of this study was to analyze the long-term outcomes of extensor tendon ruptures of the knee using exact measuring tools. Methods The results of patients treated for extensor tendon rupture with a minimum follow up of 10 years were reviewed. Electromyography (EMG) and three-dimensional (3D) gait analyses were performed and compared with the healthy side of each patient and with the gait patterns of 20 healthy controls. Functional outcome scores were assessed using the Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results After a mean of 13.4 ± 3 years, 23 patients were available for follow up. The mean Lysholm score was 86.6, and the KOOS averaged 78.1. Gait analysis showed no major kinematic differences between these patients compared with healthy controls. In the squat test, the mean peak amplitude of the rectus femoris muscle was significantly smaller on the injured side than on the healthy side (140.21 ± 66.13 μV vs. 168.25 ± 91.77 μV; P = 0.01). The mean peaks of the vastus lateralis and medialis EMG signals were also lower on the injured side (P = 0.63; P = 0.08). Correspondingly, the thigh girth at 20 cm and 10 cm above the knee was significantly lower on the injured side. One patient had re-rupture after patella tendon repair. Conclusion At long-term follow up the patients reached good clinical outcomes and exhibited mainly physiological gait patterns after rupture of knee extensor tendons. However, the thigh muscles showed hypotrophy and a significantly smaller EMG signal amplitude during a high-intensity task on the formerly injured side.

We described the case of a 12-year-old patient who presented isolated contracture of the left rectus femoris muscle with subsequent traumatic rupture of the distal myotendinous junction; for this reason she did not present contracture in extension of the knee but she presented dynamic contracture in flexion of the hip (Ely positive test), which generated great impact on walking. Surgical management with tenotomy of the anterior rectum was performed, obtaining good results. This pathology has low incidence and it has been reported little in the literature, so it is important to suspect it. We provide an updated diagnostic and therapeutic approach.

Ferris, JR, Tomlinson, MA, Ward, TN, Pepin, ME, and Malek, MH. Reduced electromyographic fatigue threshold after performing a cognitive fatiguing task. J Strength Cond Res 35(1): 267-274, 2021-Cognitive fatigue tasks performed before exercise may reduce exercise capacity. The electromyographic fatigue threshold (EMGFT) is the highest exercise intensity that can be maintained without significant increase in the electromyography (EMG) amplitude vs. time relationship. To date, no studies have examined the effect of cognitive fatigue on the estimation of the EMGFT. The purpose of this study, therefore, was to determine whether cognitive fatigue before performing exercise reduces the estimated EMGFT. Eight healthy college-aged men were recruited from a university student population and visited the laboratory on multiple occasions. In a randomized order, subjects performed either the cognitive fatigue task (AX continuous performance test) for 60 minutes on one visit (experimental condition) or watched a video on trains for 60 minutes on the other visit (control condition). After each condition, subjects performed the incremental single-leg knee-extensor ergometry test while the EMG amplitude was recorded from the rectus femoris muscle and heart rate was monitored throughout. Thereafter, the EMGFT was calculated for each subject for each visit and compared using paired samples t-test. For exercise outcomes, there were no significant mean differences for maximal power output between the 2 conditions (control: 51 ± 5 vs. fatigue: 50 ± 3 W), but there was a significant decrease in EMGFT between the 2 conditions (control: 31 ± 3 vs. fatigue: 24 ± 2 W; p = 0.013). Moreover, maximal heart rate was significantly different between the 2 conditions (control: 151 ± 5 vs. fatigue: 132 ± 6; p = 0.027). These results suggest that performing the cognitive fatiguing task reduces the EMGFT with a corresponding reduction in maximal heart rate response.

de Camargo, JBB, Braz, TV, Batista, DR, Germano, MD, Brigatto, FA, and Lopes, CR. Dissociated time course of indirect markers of muscle damage recovery between single-joint and multi-joint exercises in resistance-trained men. J Strength Cond Res XX(X): 000-000, 2020-This study compared the time course of indirect markers of muscle damage after multi-joint and single-joint exercises. Ten resistance-trained men (years: 26.9 ± 3.0; total body mass: 83.2 ± 13.8 kg; height: 176 ± 7.0 cm; resistance training [RT] experience: 5.5 ± 2.4 years; RT frequency: 5.3 ± 0.7 sessions; relative squat 1 repetition maximum: 1.4 ± 0.3) performed, in a random order, 5 sets of 8 repetition maximum of the back squat (BS) and knee extension (KE) exercises. Rectus femoris muscle thickness (MTRF), leg circumference (LC), and muscle soreness (MS) were recorded at baseline (pre), 0, 12, 24, and 36 hours after each exercise protocol. There was a significant increase (p < 0.05) in dependent variables at every time point after both the multi-joint and single-joint exercise sessions. However, MTRF and LC were greater at 0 and 36 hours, and MS was greater at 24 and 36 hours after BS when compared with KE (all p < 0.05). This study shows that resistance-trained individuals can experience significant higher levels of indirect markers of muscle damage when performing a multi-joint lower-limb exercise compared with a single one.

Song et al. reported an anterolateral thigh (ALT) flap as a septocutaneous flap in 1984. Conventionally anterolateral thigh flap is based on the perforators arising from the descending branch of the lateral circumflex femoral artery (LCFA), accompanied by two venae comitantes, one on either side. We present an infrequent anatomical presentation of descending branch of LCFA in which two arteries accompanied a single central vein. This pattern was exactly the opposite of conventional anatomy. One of the arteries (lateral) was arising from the LCFA main trunk, and the other (medial) artery was emerging from the LCFA branch to the rectus femoris muscle. The larger artery was used for arterial anastomosis, and the lone vein was used for venous anastomosis. The patient had an uneventful recovery. To the best of our knowledge, the unusual pattern described above is not reported before. Level of Evidence: Level V, risk / prognostic study

Electrical stun devices (ESDs) serve a basic role in law enforcement and provide an alternative to lethal options for target control by causing electromuscular incapacitation (EMI). A fundamental concern is the adverse health consequences associated with their use. The capability of EMI electric field pulses to disrupt skeletal muscle cells (i.e. rhabdomyolysis) was investigated over the operational range commonly used in commercial EMI devices. Functional and structural alteration and recovery of muscle and nerve tissue were assessed. In an anesthetized swine model, the left thigh was exposed to 2 min of electrical pulses, using a commercially available ESD or a custom-made EMI signal power amplifier. Serum creatinine phosphokinase (CPK), troponin, aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels were monitored intermittently for 6 h post-EMI exposure. A standard external cardiac defibrillator served as a positive control. Muscle and nerve tissue histology adjacent to the EMI contacts were examined. Post-EMI shock skeletal muscle function was evaluated by analyzing the compound muscle action potentials (CMAPs) of the rectus femoris muscle. Maximal energy cardiac defibrillator pulses resulted in rhabdomyolysis and marked elevation of CPK, LDH, and AST 6 h post-shock. EMI field pulses resulted in the animals developing transient acidosis. CMAP amplitudes decreased approximately 50% after EMI and recovered to near-normal levels within 6 h. Within 6 h post-EMI exposure, blood CPK was mildly increased, LDH was normal, and no arrhythmia was observed. Minimal rhabdomyolysis was produced by the EMI pulses. These results suggest that EMI exposure is unlikely to cause extremity rhabdomyolysis in normal individuals. Bioelectromagnetics. © 2020 Bioelectromagnetics Society.

As modalidades de estimulação elétrica (EE) podem ser utilizadas para promover alívio de dor ou gerar força muscular. Entretanto, observa-se que existem poucos estudos que analisam o Limiar de Tolerância de Dor à Pressão (LTDP) em parâmetros que promovem fortalecimento muscular. Objetivamos verificar e comparar o LTDP após a EE com parâmetros indicados para o fortalecimento muscular em indivíduos saudáveis. Para isso participaram 51 mulheres randomizadas em três grupos (n=17 cada): RUSSA, AUSSIE e FES. A EE foi aplicada por 10 minutos com intensidade em nível motor no músculo quadríceps direito. O quadríceps esquerdo foi utilizado como controle. Avaliou-se o LTDP no músculo reto femoral pela algometria de pressão antes, imediatamente após, 30 minutos após e 1 hora após a eletroestimulação. Quando comparado com o controle, o grupo FES apresentou aumento estatisticamente significativo no LTDP imediatamente após a EE (p=0,009), enquanto o grupo RUSSA apresentou diferença estatística 30 minutos após a EE (p=0,007), mas com aumento significativo no lado controle. No grupo AUSSIE não houve diferença estatística entre os lados em nenhuma das situações avaliadas. Na comparação entre os momentos avaliados no lado experimental, o grupo FES apresentou um aumento significativo no LTDP imediatamente após e 30 minutos após a EE (p=0,03). As demais comparações não apresentaram diferenças significativas. Os dados deste estudo sugerem que a EE pode aumentar o LTDP por meio da corrente FES, quando utilizada com parâmetros para fortalecimento muscular.

Active straight leg raising (ASLR) is a fundamental test and used in the Functional Movement Screen (FMS). In the ASLR of the FMS, one subgroup performs the movement correctly without any compensation (ASLR-3), whereas another subgroup has limitations in ASLR but not the passive straight leg raising (ASLR-1-SMCD). We aimed to investigate whether abdominal muscle activities in ASLR are different between individuals with ASLR-1-SMCD and ASLR-3. The relative latency of the onset of the following muscles to the right rectus femoris muscle during the right ASLR and the amplitude of activity in the following muscles for 50 msec after the onset of rectus femoris muscle activity were compared: left rectus abdominal, bilateral external oblique, bilateral internal oblique, and left gluteus maximus muscles. Data of 17 participants with ASLR-3 and 34 participants with ASLR-1-SMCD, whose sex ratio was matched to the ASLR-3 group, were analyzed. Those with ASLR-1-SMCD had statistically significant delays in the relative latency of the right internal oblique muscle (46.32±70.83 msec) and left gluteus maximus muscle (100.36±75.40 msec) muscles compared with those with ASLR-3 (right internal oblique muscle=9.75±23.07 msec, left gluteus maximus muscle=57.50±36.89 msec). However, the difference in the amplitude of activity in any muscles was not significant. The ASLR-1-SMCD group had greater relative latency of the onset of right internal oblique muscle and left gluteus maximus muscle to the onset of the right rectus femoris muscle during the right ASLR compared with the ASLR-3 group.

The purpose of this study was to determine if muscular dimensional changes with increases in torque production are influenced by age- and obesity-related increases in intramuscular fat, and its relationship to percent body fat (%BF), echo intensity (EI), strength, and maximum walking speed. Sixty-six healthy men were categorized into 3 groups based on age and body mass index status (young normal weight [YNW], older normal weight [ONW], and older obese [OB]). Participants underwent %BF assessments, resting ultrasonography to determine muscle size (cross-sectional area [CSA]) and EI of the superficial quadriceps, and a 10-m maximum walking speed assessment. Maximal and submaximal (rest–100% MVC in 10% increments) isometric leg extension strength was assessed while changes in rectus femoris (RF) CSA, width, and depth were obtained with ultrasonography. Echo intensity and %BF were different among all groups (p ≤ .007), with the YNW and OB groups exhibiting the lowest and highest %BF and EI values, respectively. The RF increased in depth and decreased in width with increases in torque intensity for all groups. The ONW group demonstrated no change (−0.08%) in RF CSA across torque intensities, whereas the YNW group (−11.5%) showed the greatest decrease in CSA, and the OB group showed a more subtle decrease (−4.6%). Among older men, a greater change in RF CSA was related to poorer EI (r = −0.355) and higher %BF (r = −0.346), while a greater decrease in RF width was associated with faster walking speeds (r = −0.431). Examining muscular dimensional changes during contraction is a unique model to investigate the influence of muscle composition on functional performance.

Electrical muscle stimulation is widely used to enhance lower limb mobilization. Although upper limb muscle atrophy is common in critically ill patients, electrical muscle stimulation application for the upper limbs has been rarely reported. The purpose of this study was to investigate whether electrical muscle stimulation prevents upper and lower limb muscle atrophy and improves physical function.Randomized controlled trial.Two-center, mixed medical/surgical ICU.Adult patients who were expected to be mechanically ventilated for greater than 48 hours and stay in the ICU for greater than 5 days.Forty-two patients were randomly assigned to the electrical muscle stimulation (n = 17) or control group (n = 19).Primary outcomes were change in muscle thickness and cross-sectional area of the biceps brachii and rectus femoris from day 1 to 5. Secondary outcomes included occurrence of ICU-acquired weakness, ICU mobility scale, length of hospitalization, and amino acid levels. The change in biceps brachii muscle thickness was -1.9% versus -11.2% in the electrical muscle stimulation and control (p = 0.007) groups, and the change in cross-sectional area was -2.7% versus -10.0% (p = 0.03). The change in rectus femoris muscle thickness was -0.9% versus -14.7% (p = 0.003) and cross-sectional area was -1.7% versus -10.4% (p = 0.04). No significant difference was found in ICU-acquired weakness (13% vs 40%; p = 0.20) and ICU mobility scale (3 vs 2; p = 0.42) between the groups. The length of hospitalization was shorter in the electrical muscle stimulation group (23 d [19-34 d] vs 40 d [26-64 d]) (p = 0.04). On day 3, the change in the branched-chain amino acid level was lower in the electrical muscle stimulation group (40.5% vs 71.5%; p = 0.04).In critically ill patients, electrical muscle stimulation prevented upper and lower limb muscle atrophy and attenuated proteolysis and decreased the length of hospitalization.

Background Acute skeletal muscle wasting in critical illness is associated with excess morbidity and mortality. Continuous feeding may suppress muscle protein synthesis as a result of the muscle-full effect, unlike intermittent feeding, which may ameliorate it. Research Question Does intermittent enteral feed decrease muscle wasting compared with continuous feed in critically ill patients? Study Design and Methods In a phase 2 interventional single-blinded randomized controlled trial, 121 mechanically ventilated adult patients with multiorgan failure were recruited following prospective informed consultee assent. They were randomized to the intervention group (intermittent enteral feeding from six 4-hourly feeds per 24 h, n = 62) or control group (standard continuous enteral feeding, n = 59). The primary outcome was 10-day loss of rectus femoris muscle cross-sectional area determined by ultrasound. Secondary outcomes included nutritional target achievements, plasma amino acid concentrations, glycemic control, and physical function milestones. Results Muscle loss was similar between arms (–1.1% [95% CI, –6.1% to –4.0%]; P = .676). More intermittently fed patients received 80% or more of target protein (OR, 1.52 [1.16-1.99]; P Interpretation Intermittent feeding in early critical illness is not shown to preserve muscle mass in this trial despite resulting in a greater achievement of nutritional targets than continuous feeding. However, it is feasible and safe. Trial Registry ClinicalTrials.gov; No.: NCT02358512; URL: www.clinicaltrials.gov

Purpose: Skeletal muscle mass (SMM) depletion and sarcopenia as predictors of postoperative complications and poorer overall survival (OS) have been validated in many surgical fields through cross-sectional imaging (CT, MRI), with potential limitations. We evaluated it in a stage III–IV head and neck squamous cell carcinoma (HNSCC) surgical cohort through ultrasound (US) of rectus femoris muscle (RF), a quick, cheap, repeatable alternative. Methods: Patients submitted to surgical treatment with curative purpose were recruited and prospectively evaluated through clinical, biometric, biochemical, surgical, pathological and functional prognosticators and with preoperative US of RF with regards to 30-day complications and OS. Results: Forty-seven patients completed the study. RF cross-sectional area (RF-CSA) was used to identify patients with low SMM (CSA ≤ 0.97cm2: 18/47, 38.3%). RF-CSA was lower in complicated cases (0.95 ± 0.48 vs 1.41 ± 0.49cm2; p = 0.003), remaining the only independent predictor of postoperative complications at multivariate analysis, with a model including ASA score and modified Frailty index (OR 9.84; p = 0.004). SMM depletion significantly impaired OS (13.6 ± 2.9 vs 26.3 ± 2.1months; p = 0.017), being its only independent prognosticator at multivariate Cox regression analysis (OR 4.42; p = 0.033). Conclusion: RF-CSA, evaluated with US, seems a reliable method for identification of patients with low SMM in a stage III–IV HNSCC cohort, defining a subset at high-risk of 30-day complications and poorer OS.

Objective In Para-cycling competitions, cyclists with amputation of one-leg and no prosthesis, i.e., Division Cycle, Sport Class C2, perform pedaling movement on bicycle by unilateral leg. The purpose of this study was to describe neuromuscular activation of lower extremity muscles in two cyclists with single leg amputation and one cyclist with two legs during pedaling. We compared averaged rectified values (ARV) of surface electromyography for lower extremity muscles during crank cycle for two single leg cyclists with one cyclist with two legs at 65%, 80%, and 95% of VO2 max. Results Characteristic features of cyclists with single amputation of leg were increases in ARV for proximal region of the rectus femoris muscle in first half of pulling phase, increases in ARV for the biceps femoris muscle in first half of pulling phase, and increases in ARV for the medial gastrocnemius muscle in pulling phase. These findings in this study suggest that cyclists with single amputation of leg use characteristic neuromuscular coordination in the muscles contributing to hip and knee flexion joint moments during pulling phase and this may be the strategy in cyclists with single amputation of leg to compensate lack of hip and/or knee extension torque from contralateral leg.

Analysis of muscle composition using ultrasound requires standardization of several equipment settings (i.e. gain). However, the influence of image resolution, which is altered by imaging depth, on measures of muscle composition is unknown.We analysed rectus femoris muscle composition using ultrasound images captured from 32 males and females (aged 28 ± 5 years) at depths of 9.0, 7.3, 5.9 and 4.7 cm. The transducer's orientation was fixed using a clamp during image acquisition to minimize movement. Across each image resolution, a region of interest encompassing the same anatomical area within the muscle was used for muscle composition analysis. Muscle composition was analysed using a combination of first-, second- and higher-order texture features. Muscle composition agreement across image resolutions was evaluated using a one-way ANOVA and intraclass correlation coefficients (ICC).Most muscle composition features displayed differences due to image resolution (p .05). ICCs demonstrated poor-to-good agreement across different image resolutions. In general, higher resolution images (i.e. shallower imaging depth) demonstrated better agreement (ICC 0.90) compared to lower resolution images.Ultrasound image resolution influences muscle composition analysis. Image resolution should be fixed within and between individuals when evaluating muscle composition using ultrasound.

Objective Groin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative debridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. Methods Clinical data between 2012 and 2018 were retrospectively analyzed. Data were summarized, and standard statistical analysis was performed. Results There were 23 patients who underwent 24 RFFs for coverage of complex groin wounds after femoral artery reconstructions. One of the 23 patients underwent bilateral RFFs. In this study cohort, patients had a median age of 67.5 years, and 79% (n = 19) were male. Median body mass index was 28.0 kg/m2, and 38% of patients were classified as obese on the basis of body mass index criteria. A history of tobacco use was present in 88%; however, only 29% were current smokers. Diabetes was present in 38% of patients and chronic kidney disease in 29%. Of the 24 RFFs, 14 (58%) were constructed in patients with reoperative groin surgery resulting in the need for muscle flap coverage. Femoral endarterectomy was the most common index procedure (46%), followed by infrainguinal leg bypass surgery (17%) and aortobifemoral bypass (17%). Grafts used during the original reconstruction included 12 bovine pericardial patches (50%), 6 Dacron grafts (25%), 4 PTFE grafts (17%), and 2 autogenous reconstructions (8%). Microbiology data identified 33% of patients (n = 8) to have gram-positive bacterial infections alone, 21% (n = 5) to have gram-negative infections alone, and 29% (n = 7) to have polymicrobial infections; 4 patients (13%) had negative intraoperative culture data. Median hospital stay after RFF was 8 days, and median follow-up time was 29.3 months. Major amputation was avoided in 20 of 24 limbs (83%) undergoing RFF. Eight patients underwent intentional graft or patch explantation (33%) before RFF, whereas 14 of the remaining 15 patients (93%) had successful salvage of the graft or patch after RFF. Two of the patients (13%) who underwent RFF with the intention of salvaging a prosthetic graft or patch required later graft excision. After RFF, 30-day and 1-year survival was 96% and 87%, respectively. Conclusions RFF coverage of complex groin wounds after femoral artery reconstructions may safely be performed by vascular surgeons with excellent outcomes.

Objective There is currently no diagnostic test for PMR. A characteristic pattern of extracapsular inflammation as assessed by contrast-enhanced MRI (ceMRI) has recently been described in the pelvis of patients with PMR. We aimed to evaluate the performance of inflammatory ceMRI signals at predefined pelvic sites as a diagnostic test for PMR. Methods Pelvic MRI scans of patients with pelvic girdle pain (n = 120), including 40 patients with an expert diagnosis of PMR and 80 controls with other reasons for pelvic pain were scored by three blinded radiologists, who evaluated the degree of contrast enhancement at 19 predefined tendinous and capsular pelvic structures. Different patterns of involvement were analysed statistically. Results The frequency of bilateral peritendinitis and pericapsulitis including less common sites, such as the proximal origins of the m. rectus femoris and m. adductor longus, differed significantly between PMR cases and controls: 13.4 ± 2.7 vs 4.0 ± 2.3. A cut-off of ≥10 inflamed sites discriminated well between groups (sensitivity 95.8%, specificity 97.1%). Bilateral inflammation of the insertion of the proximal m. rectus femoris or adductor longus tendons together with ≥3 other bilaterally inflamed sites performed even better (sensitivity 100%, specificity 97.5%). Conclusion This study confirms that a distinctive MRI pattern of pelvic inflammation (bilateral peritendinitis and pericapsulitis and the proximal origins of the m. rectus femoris and m. adductor longus) is characteristic for PMR. The high sensitivity and specificity of the set of anatomical sites evaluated suggests their clinical usefulness as a confirmatory diagnostic test.

Introduction A freshwater fish Ophiocephalus striatus (OS) or known locally to Indonesian as haruan, has potentials to retain musclemass of critically ill patients following its high content of amino acids, fatty acids, minerals, and vitamins. This study was conducted to investigate the effect of OS on quantitative measurements of biceps brachii and rectus femoris in patients with mechanical ventilation. Methods This was a double-blinded randomized controlled trial at tertiary hospital between July- September 2019. The study included patients aged 18-65 years old with mechanical ventilation whereas patients with chronic kidney disease, paraparesis, or neuromuscular disorders were excluded. Forty-two patients were divided into extract group (n=19) who received 15 g of OS extract daily and control group (n=23) who received none. Quantitative measurements of both muscles were determined by measuring cross sectional area (CSA) using ultrasonography by one radiologist. Data were collected at 1st and 7th day, while the intervention was administered in-between. Independent sample T-test, Mann-Whitney test, and multivariate study using general linear model (GLM) were used for statistical analysis. Results The changes of CSA on biceps brachii and rectus femoris muscles from before to after intervention between extract group compared to control group were 5,30 ± 2,41 to 6,09 ± 1,81 vs. 5,16 ± 2,50 to 4,16 ± 1,94 (p=0.002) and 2,45 (1,10 – 5,90) to 3,47 (1,13 – 8,18) vs 3,85 (1,09 – 9,06) to 2,78 (1,06 – 7,27) (p=0.230), respectively. Multivariate analysis showed significant differences between extract and control group for both muscles with p value of

Background: Whole body-electromyostimulation (WB-EMS) is widely used for the rehabilitation and recovery of patients with various neuromusculoskeletal disorders.Objects: To objectively measure changes in lower extremity and abdominal muscles after sit-to-stand dynamic movement training using WB-EMS.Methods: A total of 46 healthy adults (23 experimental and 23 control subjects) performed sit-to-stand exercise; the experimental group with WB-EMS, and the control group without WB-EMS. The muscle activity of the lower extremity, and the muscle thickness of the lower extremity and abdominal muscles were measured before and after the intervention.Results: In terms of electromyographic activity, there was a significant interaction effect for the rectus femoris (RF) muscle (F=30.212, p=.000). With regards to ultrasonographic imaging, the muscle thickness of the RF muscle had a significant interaction effect at the muscle contraction ratio (F=8.071, p=.007). The deep abdominal muscles, such as the transverse abdominal (TrA) and internal oblique (IO) muscles, also showed significant interaction effects at the muscle contraction ratio (F=5.474, p=.024, F=24.151, p=.000, respectively)Conclusion: These findings suggest that WB-EMS may help to improve the muscular activity of the RF muscle, and the muscle thickness of the RF muscle and deep muscles such as the TrA and IO muscles.

Purpose The aim of this study was to propose the qualitative and quantitative approaches to evaluate the skeletal muscle ultrasound images of 23 Pompe disease (i.e., acid maltase deficiency, AMD) patients and 14 normal subjects. Methods A cohort of 23 AMD patients and 14 normal subjects has been investigated. We compared the B-mode echo intensity of the rectus femoris muscle with that of its surrounding fat (subcutaneous fat) and proposed a qualitative grading method. Quantitative analysis of the region of interest (ROI) with the echo intensity and the segmented area was also performed. Results Qualitative results showed that AMD patients without clinical symptoms (without undergoing ERT) had the highest distribution of Grade 1, and AMD patients undergoing ERT had the widest distribution of Grade 2, and control group (n = 14) with the highest distribution of Grade 1. Using the segmented area approach, quantitative results showed that AMD patients undergoing ERT had the largest and widest distribution. Meanwhile the control subjects (normal subjects) had the lowest and the narrowest areas. The echo intensity of the segmented ROI of AMD patients undergoing ERT displayed the highest and widest (inhomogeneous) distributions. By contrast, the echo intensity of AMD patients without clinical symptoms was slightly increased and with low inhomogeneity. Conclusion The proposed ultrasonography-based qualitative and quantitative approach may be used to evaluate the severity of muscle destruction for AMD patients. Besides, the quantitative segmented area with regression analysis could help predict the incidence of onset of Pompe disease patients.

Paratonia, a form of hypertonia typically seen in dementia, is often associated with difficulties in positioning and daily care. No evidence-based therapy or clinical guideline for management is available. In this study, the short-term effect of harmonic techniques (HT) and supporting cushions (SC) on paratonia was explored.This was a multicenter interventional clinical trial with AB/BA crossover design. Each intervention (SC or HT) was subsequently implemented over 1 week in each of the participants.The study included 22 participants with moderate to severe paratonia from 9 different nursing homes in Flanders, Belgium.Measurements of biceps brachii and rectus femoris muscle tone (MyotonPRO), maximal elbow and knee extension (goniometer), and pain (Pain Assessment Checklist for Seniors With Limited Ability to Communicate) were performed on 3 different days within 1 week. The effect of HT on nursing care was evaluated with the Pain Assessment Checklist for Seniors With Limited Ability to Communicate and visual analog scale ratings of discomfort items.After 30 minutes of positioning with SC, participants had lower biceps brachii muscle tone (P = .041) and higher maximal elbow extension (P = .006) than without SC. After a 30-minute session of HT, a significant increase in biceps brachii muscle tone (P = .032) and maximal extension of elbow (P .001) and knee (P = .028) was found. Pain (P = .003) and discomfort (P = .001 to P = .019) during morning care were significantly lower when care was preceded by 30 minutes of HT.This explorative study revealed beneficial short-term effects on range of motion for both SC and HT and a positive effect of SC on upper limb muscle tone. Beneficial effects of HT were found on resident's pain and caregiver's discomfort during care. The results of the present study are encouraging and can contribute to the development of evidence-based interventions for paratonia.

In recent years, whole-body vibration (WBV) training has been used as a training method in health promotion. This study attempted to use WBV at three different frequencies (20, 30, and 40 Hz) with subjects from different age groups to analyze the activation of the rectus femoris muscle. The subjects included 47 females and 51 males with an average age of 45.1 ± 15.2 years. Results indicated significant differences in subjects from different age groups at 20 Hz WBV. Muscle contraction was greater in the subjects who were older (F(4,93) = 82.448, p &lt, 0.001). However, at 30 Hz WBV, the difference was not significant (F(4,93) = 2.373, p = 0.058). At 40 Hz WBV, muscle contraction was less in the older subjects than in the younger subjects (F(4,93) = 18.025, p &lt, 0.001). The spectrum analysis also indicated that at 40 Hz there was less muscle activity during WBV in the older subjects than in the younger ones. Therefore, age was found to have a significant effect on muscle activation during WBV at different frequencies. If the training is offered to elderly subjects, their neuromuscular responses to 20 Hz WBV will be more suitable than to 40 Hz WBV.

Background: A complete avulsion of the proximal rectus femoris muscle is a rare but severity injury. There is a lack of substantial information for its operative treatment and rehabilitation; in particular there is a lack of biomechanical data to evaluate long-term outcomes. Case presentation: The case report presents the injury mechanism and surgical treatment of a complete avulsion of the proximal rectus femoris muscle in a 41-year-old recreational endurance athlete. Moreover, within a one-year follow-up period, different biomechanical tests were performed to get more functional insights into changes in neuromuscular control, structural muscle characteristics, and endurance performance. Within the first month post-surgery, an almost total neuromuscular inhibition of the rectus femoris muscle was present. A stepwise reduction in inter-limb compensations was observable (e.g., in crank torque during cycling) during the rehabilitation. Muscular intra-limb compensations were shown at six months post-surgery and even one year after surgery, which were also represented in the long-term adaption of the muscle characteristics and leg volumes. A changed motor control strategy was shown by asymmetric muscle activation patterns during ergometer cycling, while the power output was almost symmetric. During rehabilitation, there might be a benefit to normalizing neuromuscular muscle activation in ergometer cycling using higher loads. Conclusions: While the endurance performance recovered after six months, asymmetries in neuromuscular control and structural muscle characteristics indicate the long-term presence of inter- and intra-limb compensation strategies.

Standing yoga poses strengthen a person’s legs and helps to achieve the goal of musculoskeletal rehabilitation, but inadequate exercise planning can cause injuries. This study investigated changes in the electromyogram and joint moments of force (JMOFs) of lower extremities during common standing yoga poses in order to explore the feasibility and possible injury risk in dealing with musculoskeletal problems. Eleven yoga instructors were recruited to execute five yoga poses (Chair, Tree, Warrior 1, 2, and 3). The results revealed significant differences in hip, knee, and ankle JMOFs and varying degrees of muscle activation among the poses. Among these poses, rectus femoris muscle activation during the Chair pose was the highest, Warrior 2 produced the highest muscle activation in the vastus lateralis of the front limb, while Warrior 1 had the highest muscle activation in the vastus medialis of the back limb. Therefore, all three poses can possibly be suggested as a therapeutic intervention for quadriceps strengthening. Warrior 1 was possibly suggested as a therapeutic intervention in order to reduce excessive lateral overload of the patella, but the possible adverse effects of Warrior 2 with the highest knee adductor JMOF in the back limb could raise joint reaction forces across the medial condyles. In single-leg balance postures, Warrior 3 had unique training effects on the hamstring, and is therefore suggested as a part of hamstring rehabilitation exercises. The Tree pose induced low lower-extremity JMOFs and a low level of thigh muscle activations when it was performed by senior instructors with excellent balance control, however, for yoga beginners with insufficient stability, it will be a useful training mode for strengthening the muscles that help to keep one upright. This study quantified the physical demands of yoga poses using biomechanical data and elucidated the structures and principles underlying each yoga movement. This is crucial for yoga practitioners.

(1) Background: Hemophilic knee arthropathy is characterized by a loss of muscle mass and decreased strength of the quadriceps muscle. The visualization of movement aims to favor the recruitment of the motor system in the same premotor and parietal areas, as would happen with the active execution of the observed action. The aim was to evaluate changes in quadriceps activation in patients with hemophilic knee arthropathy following immersive VR visualization of knee extension movements. (2) Methods: We recruited 13 patients with severe hemophilia A and knee arthropathy. Patients underwent a 15 min session of immersive VR visualization of knee extension movements. The quadriceps muscle activation was evaluated by surface electromyography. (3) Results: After the intervention, there were no changes in the muscle activation of vastus medialis, vastus lateralis, or rectus femoris muscles. There was a large effect size of changes in rectus femoris muscle activation. Age and knee joint damage did not correlate with changes in quadriceps activation. Dominance, inhibitor development, and type of treatment were not related with post-intervention muscle activation. (4) Conclusions: A session of immersive VR visualization of knee extension movement does not modify quadriceps muscle activation. A specific protocol for patients with hemophilic knee arthropathy may be effective in improving the activation of the rectus femoris muscle.

Subspine impingement syndrome by definition involves a prominent antero-inferior iliac spine (AIIS) which can lead to impingement on the femoral neck thereby causing symptoms. We present the case of a 22-year-old semi-professional athlete who presented with a Type III AIIS morphology leading to subspine impingement syndrome and was managed via a mini open anterior approach. Radiological examination revealed a fairly prominent left AIIS resembling the ‘horn of a rhino’ extending to the trochanteric region anteriorly. A mini-anterior surgical approach was utilized for the resection of the ‘rhino horn’ and the rectus femoris was reattached. The patient remained asymptomatic at the one-year follow-up and had resumed weightlifting. Following this case, we propose a new classification of the type III AIIS morphology in view of the clinical presentation. The AIIS type III-Standard represents an extension from the acetabular rim to less than 1 cm (type III-S) and type III-Large, with an extension from the acetabular rim beyond 1 cm (type III-L). The type III-L will further be divided into two groups based on its relation to the ilium, type III-Lr (‘rib shape’) and type III-Lrh (‘rhino horn’).

Muscle atrophy in humans mainly occurs due to aging, lack of physical activity, and exposure to microgravity leading to decreased muscle volume and power. Several exercises coupled with various bodysuits have been used to cope with muscle atrophy. But, all state of arts failed to provide complete prevention from atrophy. Hence, a new countermeasure gravitational load modulating bodygear (CGLM bodygear) has been developed. Herein, squats exercise coupled with bodygear was used to increase the lower limbs muscle activity and evaluated by electromyography (EMG). The study was conducted by performing the squats by thirty subjects with and without bodygear. The EMG signals from the biceps and rectus femoris muscle were recorded to evaluate the electrical activity produced in both the muscles. The time domain results of EMG analysis revealed that the bodygear has enhanced biceps and rectus femoris muscle activity by 50% and 90% respectively. The frequency domain results revealed that the rate of fatigue was higher when squats was performed with bodygear as compared to without bodygear. Overall, the study has concluded that squats coupled with bodygear can be a promising countermeasure to muscle atrophy by generating higher muscle activity in lower limbs.

BACKGROUND: In medial knee osteoarthritis (knee OA), compensatory overstrain of the rectus femoris (RF) muscle leads to its hypertrophy. We hypothesize that besides hypertrophy of the RF, a prominent flattening of the central aponeurosis (CA) curvature is also indicative of RF. This study aims to evaluate the structural changes in the CA and clarify the conditions associated with RF overstrain in knee OA. OBJECTIVE: Twenty-three legs of 20 elderly without knee OA (elderly group) and 26 legs of 20 individuals with K-L grade II knee OA (knee OA group) with typical “comma”-shaped CA participated in this study. METHODS: The knee extension torque (Nm/kg) in the sitting position, the thickness of the RF and vastus intermedius (VI) muscles (VI), and change in CA curvature (%Curvature) were measured at the mid-thigh by ultrasonography. RESULTS: The knee extension torque was not significantly different between the two groups. Compared to the elderly group, the knee OA group had significantly thicker RF at rest, while the VI thickness during contraction was significantly smaller. The %Curvature was significantly higher in the knee OA group than in the elderly group. CONCLUSIONS: In the knee OA group, the RF was hypertrophic with a more pronounced CA flattening during muscle contraction, although the other quadriceps muscles were atrophic, suggesting an overstrained RF. Assessing thickness and CA curvature of the RF is, therefore, useful and simple for evaluating overstrain caused by RF compensation.

Objective. Joint torque differences between healthy and rehabilitated legs are often measured as a clinical index of recovery from muscle strain injury. Unfortunately, it should be noted that this is a questionable evaluation measure of the muscle after injury because it is a composite value including related cooperating muscles. Meanwhile, the use of ultrasound elastography for the measurement of individual muscle mechanical properties (i.e., muscle hardness) has recently expanded. The purpose of this study was to examine, using ultrasound elastography, the differences in the linear relationship between muscle contraction intensity and muscle hardness during knee extension in athletes who had recovered from grade II rectus femoris muscle strain injury through comparison of the healthy and rehabilitated legs. Methods. Six athletes participated. Rectus femoris muscle hardness, determined during isometric contraction at 10%, 20%, 30%, and 40% of maximum voluntary contraction, was evaluated using ultrasound strain elastography. Results and Conclusion. The results indicated that for the healthy legs, the strain ratios, as indicated by muscle hardness, decreased linearly (became harder) with contraction intensity, but the strain ratios for the rehabilitated legs decreased nonlinearly. These results show the danger of judging the recovery period using only the difference between healthy and rehabilitated muscle strengths and the importance of evaluating individual muscles.

Background Inguinal wound complications often cause postoperative morbidity and also mortality following vascular surgical interventions. The aim of this study was to report experiences and a comparison of the outcomes using rectus femoris muscle flaps (RFF) and sartorius muscle flaps (SMF). Material and methods A retrospective study was performed at two locations of a cross-border vascular center and all muscle flap interventions performed at the two centers within the vascular surgery department were reviewed. Primary outcomes were muscle flap survival, graft salvage and major amputations. Results A total of 44 RFFs were performed in 39 patients (mean age 67 years, 73% males) and 25 SMFs in 24 patients (mean age 64 years, 76% males). Wound infections were the most common indications for muscle flap reconstruction. At a mean follow-up of 24 months (±24) and 17 months (±20), respectively, comparable flap survival rates (91% vs. 84%), wound healing rates (72% vs. 83%), graft salvage (65% vs. 73%) and amputation rates (9% vs. 8%) were found. Conclusion Muscle flap reconstruction is an effective way to cover groin defects resulting from deep wound infections after vascular surgery, achieving good results in a high-risk group of patients. No differences were found between SMF and RFF regarding amputation and graft loss. Both techniques can be safely performed, depending on the preference and experience of the surgical team. The RFF technique should be preferentially used to cover large tissue defects, whereas the SMF procedure can be preferred to cover smaller defects in the groin.

BACKGROUND Knee stability has an important role in the gait of hemiplegic stroke patients. However, factors affecting knee stability have not been assessed concerning gait. The purpose of this study was to explore whether co-contraction of the lower limb muscles contributes to the knee stability during the stance phase of the gait cycle in hemiplegic stroke patients. MATERIAL AND METHODS A total of 30 hemiplegic stroke patients, ages 36-79 years, were instructed to walk at their natural speed. The root mean square of surface electromyography was used to measure activities of the biceps femoris and rectus femoris muscles, while the co-contraction ratio was computed based on the root mean squares. The peak angle of knee extension was acquired in the stance phase by 3D kinematic analyses. Lower limb function was evaluated using the Fugl-Meyer scale for lower limb motor assessment. RESULTS A statistically significant increase of the muscle co-contraction ratio of the involved extremity was observed compared with that of the uninvolved extremity (t=-4.066, P

To determine the incidence of the iliocapsularis muscle in fetal period and its relationship with the hip joint capsule. Twenty-one formalin-fixed fetuses (12 female and 9 male) with a mean gestational age of 29 ± 3.89 weeks (range 25–36) were dissected to reveal morphological properties of iliocapsularis muscle. Iliocapsularis muscle was observed in 39 out of 42 sides (92%). Its proximal attachment was detected either below the proximal attachment of rectus femoris muscle in 21 out of 39 sides (54%), or it was forming a common tendon with rectus femoris on the anterior inferior iliac spine in 10 out of 39 sides (26%), or it was forming an arch along the superior–medial–inferior sides of the proximal attachment of rectus femoris muscle in 8 out of 39 sides (20%). Muscle fibers originating from the anteromedial part of hip joint capsule were also constant in all sides. Distal attachment of iliocapsularis muscle was distal to the lesser trochanter in all specimens. Its form was as a broad muscle in 32 out of 39 sides (82%) and as a thin rectangular muscular slip in 7 out of 39 sides (18%). Iliopsoas and iliocapsularis muscles had their particular fascia in 34 out of 39 sides (87%), and in the other 5 sides, there was no fascia which prominently separated the two muscles. Its length was longer in females than males (p = 0.031) and it was wider on the right side (p = 0.029). Linear functions were y = 0.49 + 0.17 × weeks and y = 6.94 + 0.89 × weeks for width and length, respectively. Data obtained with the present study about iliocapsularis muscle in fetal period revealed that it is an individual and constant muscle. Its dimension, location, and course over the hip joint capsule support the idea that it tightens the hip capsule and stabilizes the femoral head.

Objectives To compare hip flexor muscle cross-sectional area (CSA) in ballet dancers and athletes, and to evaluate the relationship between hip flexor size and hip pain. Study design Case control study. Setting Elite ballet and sport. Participants 33 professional ballet dancers and 33 age and sex-matched athletes. Main outcome measures CSA's of hip flexor muscles iliopsoas, rectus femoris, sartorius and tensor fascia latae (TFL) on magnetic resonance imaging (MRI) of one hip. Hip pain was scored with the Copenhagen Hip and Groin Outcome Score (HAGOS): HAGOS pain score of 100 was defined as no pain and a score less than 100 was defined as pain. Participants' weight and height. Results Dancers had larger iliopsoas (P Conclusion Ballet appears to selectively load iliopsoas, TFL and sartorius muscles but not rectus femoris. Iliopsoas muscle size was smaller in participants with hip pain, but TFL, sartorius and rectus femoris muscle size was not related to hip pain.

Sarcopenia is a geriatric syndrome related to loss of muscle mass and function, leading to disability, frailty and higher mortality. According to European Working Group on Sarcopenia in Older People (EWGSOP) the diagnosis of sarcopenia requires the assessment of muscle mass, muscle force and function, that is time-consuming and not easily at hand in everyday clinical practice. We propose the B-mode ultrasound measurement of muscle thickness as a quick screening test to assess the presence of sarcopenia.A cross-sectional study was realized, 119 patients (average age 82 years, 50.4% females) from the Department of Internal Medicine of the University Hospital of Siena (Italy) were enrolled. The diagnosis of sarcopenia was assessed according to EWGSOP criteria. Rectus femoris muscle (RFM) thickness (in cm) was measured by ultrasound B-mode scanning. Sensibility and specificity of the test was evaluated and Receiver Operating Analysis (ROC) was performed to assess the accuracy of the test.Average RFM thickness was 0.78 ± 0.26, significantly lower in sarcopenic patients (0.55 ± 0.2 vs. 0.9 ± 0.3; Mann-Whitney; p 0.001) and females (0.7 ± 0.3 vs 0.86 ± 0.3; Mann-Whitney; p 0.001). The cut-off point of 0.7 cm for females and 0.9 cm for males was established as a threshold to assess the presence of sarcopenia by ultrasound. Sensibility of ultrasound measurement of RFM thickness was 100%, specificity 64%, positive predictive value (PPV) 64.3% and negative predictive value (NPV) 100%. ROC analysis was performed in order to quantify how accurately RFM thickness can discriminate between sarcopenia and non-sarcopenia state. AUC for all patients was 0.9 and after a comparative analysis for gender higher values for males (0.94 vs. 0.92) were observed.We suggest a screening test for sarcopenia based on the ultrasound measurement of RFM thickness, as a not invasive and easy to perform method even in elderly patients with functional or cognitive impairment.

Introduction: This study aimed to investigate the onset time and the electromyographic activity level of the selected lower limb muscles in the active and inactive old women. Materials and Methods: In this case-control study, 28 old women with a Mean±SD age of 61.07±0.88 years were selected in the inactive (15 people) and active (13 people) groups. The electrical activity of the selected muscles of the lower limbs was collected by the EMG device in a stair down movement. Results: The onset time of tibialis anterior, vastus lateralis, and biceps femoris muscles are faster in the active group (p

The aim of this study was to evaluate the feasibility of quantitative analysis of muscle stiffness in the rectus femoris muscle (RFM) by acoustic radiation force impulse (ARFI) ultrasound elastography in children with chronic kidney disease (CKD). Twenty-three children with CKD and 22 healthy children participated in the study in our radiology department. The strength of each CKD group and healthy group participants' tight extensors was assessed by a physiatrist using a handheld dynamometer. Acoustic radiation force impulse was used to measure the shear wave velocities (SWVs) of the RFM. The mean SWV value of the RFM correlated with the strengths of the tight extensors in the CKD and healthy groups. The mean ± SD SWV values of the RFM in the CKD group for the right (n = 23) and left sides (n = 21) were 1.23 ± 0.25 and 1.26 ± 0.30 m/s, respectively. The mean ± SD SWV values of the RFM in the healthy group for the right (n = 23) and left sides (n = 21) were 1.62 ± 0.33 and 1.65 ± 0.35 m/s, respectively. The SWV of the RFM significantly decreased in the patients with CKD when compared with controls (P < 0.001). The SWV values were not correlated to the handheld dynamometry. The interobserver agreement expressed as the interclass correlation coefficient was 0.65 (95% confidence interval, 0.33-0.84; P < 0.001). The acoustic radiation force impulse demonstrates a difference in RFM muscle stiffness between the CKD and healthy groups. This method is a feasible imaging method for the noninvasive assessment of muscle weakness in children with CKD.

Femoroacetabular impingement syndrome (FAIS) surgery can produce improvements in function and patient satisfaction; however, data on muscle assessment and kinematics of high mobility tasks of post-operative patients is limited. The purpose of this study was to evaluate kinematics and muscle activity during a deep squat task, as well as muscle strength in a 2-year follow-up FAIS corrective surgery. Eleven cam morphology patients underwent motion and electromyography capture while performing a squat task prior and 2-years after osteochondroplasty and were BMI-, age- and sex-matched to 11 healthy control (CTRL) participants. Isometric muscle strength, flexibility and patient-reported outcome measures (PROMs) were also evaluated. Post-operative FAIS was significantly weaker during hip flexion (23%) and hip flexion-with-abduction (25%) movements when compared with CTRL, no improvements in squat depth were observed. However, post-operative FAIS increased the pelvic range of motion during the squat descent (P = 0.016) and ascent (P = 0.047). They had greater peak activity for the semitendinosus and total muscle activity for the gluteus medius, but decreased peak activity for the glutei and rectus femoris during squat descent; greater total muscle activity for the tensor fascia latae was observed during squat ascent (P = 0.005). Although not improving squat depth, post-operative patients increased pelvic ROM and showed positive PROMs. The muscle weakness associated with hip flexion and flexion-with-abduction observed at the follow-up can be associated with the alterations in the muscle activity and neuromuscular patterns. Rehabilitation programs should focus on increasing pelvis and hip muscles flexibility and strength.

Adult periacetabular osteotomy (PAO) was originally performed through the classic Smith-Petersen approach for optimal operative visibility and acetabular fragment correction. Evolution towards an abductor-sparing technique significantly lowered the post-operative morbidity. The rectus-sparing approach represents a step further, but the innervation of the rectus femoris is theoretically more at risk. Although the topographic anatomy of the femoral nerve has been well described, it was never studied with specificity to surgical landmarks. The femoral nerve’s spatial relation with the anterior-inferior iliac spine (AIIS) and the amount of possible dissection in the rectus femoris and iliopsoas interval is uncertain. Seven formalin-preserved human cadaveric specimens without history of inguinal injury or surgery were dissected using the distal limb of an iliofemoral approach. The level of entry of motor innervation was measured and number of branches to the rectus femoris was noted. The average longitudinal distance from the AIIS to the first motor nerve to the rectus femoris was 8.6 ± 1.4 cm. The number of branches varied between 1 and 4 with the most common innervation pattern being composed of two segments. Dissection medial to the rectus femoris should not be carried out further than 7 cm distal to the AIIS and stretching of that interval during surgical exposure should be done cautiously. The clinical efficiency of the rectus-sparing approach should be studied further in order to confirm its advantage over the classic direct anterior approach. The study provides a better understanding of the localization and the anatomical variations of the structures encountered at the level of and below the AIIS. It also assesses the relative risk of denervation of the rectus femoris during PAO through the rectus-sparing approach. The authors recommend that the dissection medial to the rectus femoris should be carried out no further than 7 cm distal to the AIIS and stretching of that interval during surgical exposure should be done cautiously.

Objective The goal of this study was to develop a clinically feasible ultrasound (US) protocol that can detect changes in thigh muscle mass in dogs after stifle surgery. The primary aim of this study was to compare previously described US measurement locations of the canine thigh for detecting changes in muscle mass in dogs recovering from tibial plateau levelling osteotomy (TPLO). Study Design This was a prospective, exploratory pilot study. Adult dogs (n = 7) undergoing pet-owner elected TPLO were enrolled. Twelve different US measurements were performed in triplicate by a single experienced observer. Measurements were performed at 0, 2, 4 and 8 weeks after surgery at a proximal and distal location along the femur. Data from all available time points and locations were analysed for the main effect of time within modalities. Results A total of 1,008 US measurements were performed. Measurements of the transverse sectional area of the rectus femoris muscle detected significant (p ≤ 0.05) muscle loss between weeks 0 and 2 at the lateral and medial aspects of the distal location (19% and 15% respectively). Measurements of the thigh muscle thickness were significantly (p Conclusion The proximal femoral location, measured from the lateral aspect, appears to be the most suitable US measurement for detecting increases in femoral muscle mass in dogs recovering from TPLO. The provided pilot data suggest that further research evaluating this outcome measure is indicated.

Background There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). However, the best way in which to deliver SMT remains elusive because of potential interference effects amongst concurrent exercise stimuli for optimal neuromuscular and morphological adaptations. The aim of this study was to use additional outcomes (i.e. muscle strength, activation and size) from a published parent study to compare the effects of early-initiated home-based rehabilitative SMT with functional exercise training (usual care) in patients undergoing TKR. Methods A controlled clinical trial was conducted at the Orthopedic University Hospital of Rion, Greece involving allocation concealment to patients. Fifty-two patients electing to undergo TKR were randomised to either early-initiated SMT [experimental] or functional exercise training [control] in a home-based environment. Groups were prescribed equivalent duration of exercise during 12-weeks, 3–5 sessions of ~ 40 min per week of home-based programmes. Muscle strength and activation (peak force [PF]; peak amplitude [Peak Amp.] and root mean square of integrated electromyography [RMS iEMG]), muscular size (including rectus femoris muscle cross-sectional area [CSARF]), and knee ROM were assessed on three separate occasions (pre-surgery [0 weeks]; 8 weeks post-surgery; 14 weeks post-surgery). Results Patients undertaking SMT rehabilitation showed significantly greater improvements over the 14 weeks compared to control in outcomes including quadriceps PF (25.1 ± 18.5 N vs 12.4 ± 20.8 N); iPeak Amp. (188 ± 109.5% vs 25 ± 105.8%); CSARF (252.0 ± 101.0 mm2 vs 156.7 ± 76.2 mm2), respectively (p