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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 & 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

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.

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.

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.

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.

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

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.

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.

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.

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’).

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.

Background Ultrasonography (US) is a feasible and accessible method for the measurement of skeletal muscle mass. This technique presents acceptable intra-rater reliability; however, there are a few reports on its inter-rater reliability. Additionally, relative reliability should equally be inspected to determine the presence of systematic errors. Therefore, this study aimed to investigate the intra- and inter-rater reliabilities and absolute reliability of rectus femoris muscle thickness as measured using US. Methods The participants included in our study comprised 12 healthy young men (26.5 ± 3.9 years. Rectus femoris muscle thickness was measured from the right side of the thigh using US by two trained physical therapists. Inter- and intra-rater reliabilities were determined using the intraclass correlation coefficient (ICC) (1, 1) and ICC (2, 1) methods, respectively. Absolute reliability was evaluated using Bland − Altman analysis. Additionally, we calculated the minimal detectable change at the 95% level of confidence (MDC95). Result According to the results of the Bland − Altman analysis, no fixed or proportional errors were present. The ICC (1, 1) was 0.95, and the ICC (2, 1) was 0.70. The MDC95 values of rectus femoris thickness for the intra- and inter-rater reliabilities were 2.0 mm and 4.3 mm, respectively. Conclusions In our study, intra- and inter-rater reliabilities were measured at “excellent” and “moderate” levels in the healthy individuals based on a previously defined scale. Moreover, we determined the measurement error for quantifying rectus femoris thickness. Therefore, the measurement of rectus femoris thickness using US could be considered applicable in clinical research.

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.

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.

This letter presents an experimental study on balance recovery control with a lower limb exoskeleton robot. Four participants were subjected to a perturbation during standing, a forward force impulse applied to their pelvis that forced them to step forward with the right leg for balance recovery. Trials with and without exoskeleton assistance to move the stepping legs thigh were conducted to investigate the influence of the exoskeletons control assistance on balancing performance and a potential adaptation. Analysis of the body kinematics and muscle activation demonstrates that robotic assistance: first, was easy to use and did not require learning, nor inhibited the healthy stepping behavior; second, it modified the stepping leg trajectories by increasing hip and knee movement; third, increased reaction speed and decreased the step duration; and finally, generally increased biceps femoris and rectus femoris muscle activity.

WstępWięzadło krzyżowe przednie jest jedną z ważniejszych struktur stawu kolanowego. Zawiera mechanoreceptory, które dzięki wrażliwości na ruch umożliwiają odczuwanie pozycji stawowej oraz kinestezji. Uszkodzenie powoduje zmiany w funkcji kolana. W literaturze szeroko opisywane są pozycje dotyczące translacji oraz wysięku, ale coraz większą uwagę zwraca się na funkcję mięśni: siłę i sztywność. Urazowi towarzyszą uczucie niestabilności kolana i ból przy obciążeniu kończyny urazowej. Występuje również wysięk, który stopniowo ogranicza zakres ruchu w stawie, wzmaga dolegliwości bólowe oraz wtórnie może wpłynąć na funkcje mięśni. Skrócenie funkcjonalne mięśni kulszowo-goleniowych może być objawem nieprawidłowej kontroli w obrębie stawu kolanowego.Materiał i metodyBadania zostały przeprowadzone na grupie 46 mężczyzn w wieku 18–46 lat (średnia wieku 25 lat; SD 6), u których stwierdzono zerwanie więzadła krzyżowego przedniego (anterior cruciate ligament – ACL) po 5–52 tygodniach od urazu (średnia 20 tygodni; SD 15). Dokonano pomiaru długości czynnościowej mięśni kulszowo-goleniowych oraz prostego uda zarówno w sposób bierny, jak i czynny. W tym celu użyto inklinometru Saundersa, który pozwala dokonać pomiaru do 1°.WynikiAnaliza statystyczna wykazała istotną statystycznie ujemną korelację między skróceniem funkcjonalnym mięśni kulszowo-goleniowych a prostym uda w kończynie zdrowej w badaniu czynnym oraz biernym.WnioskiWraz ze wzrostem funkcjonalnego skrócenia mięśni kulszowo-goleniowych zmniejsza się skrócenie funkcjonalne mięśnia prostego uda zarówno w badaniu czynnym, jak i biernym w kończynie zdrowej. Wzrostowi skrócenia funkcjonalnego mięśni kulszowo-goleniowych towarzyszy spadek skrócenia mięśnia prostego uda w kończynie z zerwanym ACL zarówno w badaniu czynnym, jak i biernym.

The primary purpose was to examine the relationship between the muscle architectural characteristics of short and long-distance cyclist—including muscle thickness, fascicle angle, and fascicle length—of the anterior thigh and posterior leg and its impact in 20-s cycling power. The secondary purpose was to clarify the muscle variables that predict the cycling power by using ultrasonography to measure the muscle architectural characteristics. Twenty-four varsity cyclists participated in this study, of whom 12 were short-distance cyclists and 12 were long-distance cyclists. B-mode ultrasonography was used to measure muscle architecture parameters. A cycle ergometer was used to measure the cycling power. The rectus femoris, vastus medialis, and medial head of gastrocnemius were significantly thicker in short-distance cyclists than in long-distance cyclists at every site (p

AimThis study aims to simultaneously record the magnetic and electric components of the propagating muscular action potential.MethodA single-subject study of the monosynaptic stretch reflex of the musculus rectus femoris was performed; the magnetic field generated by the muscular activity was recorded in all three spatial directions by five optically pumped magnetometers. In addition, the electric field was recorded by four invasive fine-wire needle electrodes. The magnetic and electric fields were compared, and modelling and simulations were performed to compare the magnetic field vectors with the underlying muscular anatomy of the rectus femoris muscle.ResultsThe magnetomyography (MMG) signal can reliably be recorded following the stimulation of the monosynaptic stretch reflex. The MMG signal shows several phases of activity inside the muscle, the first of which is the propagating muscular action potential. As predicted by the finite wire model, the magnetic field vectors of the propagating muscular action potential are generated by the current flowing longitudinal to the muscle fiber. Based on the magnetic field vectors, it was possible to reconstruct the pinnation angle in the muscle. The later magnetic components are linked to the activated contractile apparatus.InterpretationMMG allows to analyze the muscle physiology from the propagating muscular action potential to the initiation of the contractile apparatus. At the same time this methods reveal information about muscle fiber direction and extend. With the development of high-resolution magnetic cameras, it will be possible to image the function and structure of any skeletal muscle with high precision. This method could be used in clinical medicine but also in sports and training science.What this paper adds-A robust technique for triggering a muscular action potential that can be recorded by MMG and needle EMG simultaneously-The correlation of the MMG signal with the needle EMG signal-A method for detecting the direction of the propagating muscular action potential-A method for correlating the magnetic field vectors with the pinnation angle of the examined muscle

The anteromedial thigh (AMT) flap is not our first flap of choice, mainly due to its highly variant vascular anatomy and the less favorable donor site defect compared to the ALT flap. However, it is a good option in the plastic surgeon’s armamentarium when dissecting an ALT flap and no suitable perforators are found during surgical exploration. As a matter of fact, when harvesting an ALT flap, we always perform the anteromedial incision first and we do not proceed with the lateral incision until we have verified that there are adequate perforators that can carry the ALT flap with good inflow and outflow. If no suitable perforators are found, we typically explore the medial thigh in the subfascial plane to assess whether an AMT flap can be harvested. If a good perforator of the innominate (or medial branch/rectus femoris branch) of the descending branch of the lateral femoral circumflex is found, then an AMT is an option. If the decision is made to proceed with harvesting an AMT, then the previously performed medial incision of the ALT serves as the lateral aspect of the AMT. The AMT, similarly to the ALT flap is a Cormack type B flap. As discussed above, the most common blood supply to the flap is the innominate branch which courses posteromedial to the rectus femoris muscle. If that branch is small and not suitable to carry a flap, then the flap can be shifted to a more inferomedial aspect of the thigh. The blood supply to this newly designed flap are the septocutaneous branches surrounding the sartorius muscle arising from the femoral artery and vein.

Injuries to the quadriceps muscle group are commonly seen in sporting activities that involve repetitive kicking and high-speed sprinting, including football (soccer), rugby and athletics. The proximal rectus femoris is prone to avulsion injuries as rapid eccentric muscle contraction leads to asynchronous muscle activation and different force vectors through the straight and reflected heads. Risk factors for injury include previous rectus femoris muscle or hamstring injury, reduced flexibility of the quadriceps complex, injury to the dominant leg, and dry field playing conditions. Magnetic resonance imaging (MRI) is the preferred imaging modality as it enables the site of injury to be accurately located, concurrent injuries to be identified, preoperative grading of the injury, and aids surgical planning. Non-operative management is associated with highly variable periods of convalescence, poor return to preinjury level of function and high risk of injury recurrence. Operative treatment of proximal rectus femoris avulsion injuries with surgical repair or surgical tenodesis enables return to preinjury level of sporting activity and high functional outcomes. Surgical tenodesis of proximal rectus femoris avulsion injuries may offer an avenue for further reducing recurrence rates compared to direct suture anchor repair of these injuries. Cite this article: EFORT Open Rev 2020;5:828-834. DOI: 10.1302/2058-5241.5.200055

Background: To investigate differences in magnetic resonance imaging (MRI) features of rectus femoris muscle between idiopathic pulmonary fibrosis (IPF) patients and healthy volunteers.Methods: Thirteen IPF patients with GAP Index stage II disease were subjected to pulmonary function tests, 6-minute walk test (6MWT), quadriceps femoris muscle strength measurement and MRI of the thigh at rest. At MRI, muscle cross-sectional areas, T2 and T2* relaxometry, and 3-point Dixon fat fraction were measured. The results were compared to those of eight healthy sedentary volunteers.Results: IPF patients had significantly lower %predicted FVC, FEV1 and DLCO (p

The pendulum test assesses quadriceps spasticity by dropping the lower leg of a relaxed patient from the horizontal position and observing limb movement. The first swing excursion (FS) decreases with increasing spasticity severity. Our recent simulation study suggests that the reduced initial swing results from muscle short-range stiffness and its interaction with reflex hyper-excitability. Short-range stiffness emerges from the thixotropic behavior of muscles where fiber stiffness upon stretch increases when the muscle is held isometric. Fiber stiffness might thus be higher during the first swing of the pendulum test than during consecutive swings. In addition, it has recently been suggested that muscle spindle firing reflects fiber force rather than velocity and therefore, reflex activity might depend on fiber stiffness. If this hypothesized mechanism is true, we expect to observe larger first swing excursions and reduced reflex muscle activity when the leg is moved rather than kept isometric before release, especially in patients with increased reflex activity. We performed the pendulum test in 15 children with cerebral palsy (CP) and 15 age-matched typically developing (TD) children in two conditions. In the hold condition, the leg was kept isometric in the extended position before release. In the movement condition, the leg was moved up and down before release to reduce the contribution of short-range stiffness. Knee kinematics and muscle activity were recorded. Moving the leg before release increased first swing excursion (p < 0.001) and this increase was larger in children with CP (21°) than in TD children (8°) (p < 0.005). In addition, pre-movement delayed reflex onset by 87 ms (p < 0.05) and reduced reflex activity as assessed through the area under the curve of rectus femoris electromyography (p < 0.05) in children with CP. The movement history dependence of pendulum kinematics and reflex activity supports our hypothesis that muscle short-range stiffness and its interaction with reflex hyper-excitability contribute to joint hyper-resistance in spastic CP. Our results have implications for standardizing movement history in clinical tests of spasticity and for understanding the role of spasticity in functional movements, where movement history differs from movement history in clinical tests. ispartof: Frontiers In Bioengineering And Biotechnology vol:8 ispartof: location:Switzerland status: published

Context: Fast and adequate recovery after exercise and activity is important for increasing performance and preventing injuries. Inadequate recovery usually causes changes in the biomechanical and viscoelastic properties of the muscle. Objective: To compare the immediate effect of petrissage massage (PM) and manual lymph drainage (MLD) following submaximal exercise on the biomechanical and viscoelastic properties of the rectus femoris muscle in healthy women. Design: Cross-sectional, repeated-measures. Setting: Marmara University. Participants: 18 healthy female students. Intervention(s): Following the submaximal quadriceps strengthening exercise performed in 3 sets of 8 repetitions with intensity of 75% of 1 maximum repetition, participants’ right leg received a 5-minute PM (PM group) and the contralateral leg received a 5-minute MLD application (MLD group). Main Outcome Measures: Skin temperature was measured using P45 thermographic thermal camera (Flir System; ThermaCAM, Danderyd, Sweden), and muscle tone, biomechanical, and viscoelastic features were measured with a myometer (Myoton AS, Tallinn, Estonia) at baseline, immediately postexercise, post-PM/MLD application, and 10 minutes postexercise. Results: In the PM group, the tonus (P = .002) and stiffness (P P P P P = .025), and relaxation time (P P Conclusion: PM and MLD reduce passive tissue stiffness and improve the extent of muscle extensibility over time against the muscle tensile strength. PM and MLD are therapeutic methods that can be used to support tissue recovery after exercise and prevent injuries.

Background and Aims Critically ill patients undergo important muscle wasting during ICU stay, and a significant loss of muscle mass still occurs in the first few days of hospital stay. This may delay both functional recovery and weaning from mechanical ventilation, being also a well-known predictor of mortality. Quite often, muscle wasting is masked by fluid overload, increasing the risk for underestimating the presence of malnutrition, as frequently occurs in critically ill patients with AKI. An important concern in this clinical setting is the lack of adequate tools for routine bedside evaluation of the skeletal muscle mass. Lately, the use of ultrasound (US) for the assessment of muscle mass has aroused considerable interest. It is a non-invasive technique, applicable at the bedside and even in non-collaborative patients, it is economically viable, safe and do not require specialized staff. Recently, its reliability and validity have been demonstrated in critically ill patients with AKI. On this premise, in the present study, we aimed to evaluate the clinical application of US for both evaluation and monitoring of quadriceps muscle thickness in critically ill patients with AKI. Method This is an observational study, conducted in the renal ICU of the Parma University Hospital. All adult patients with AKI, with no distinction regarding the severity of AKI, admitted in the renal ICU from 15/03/2017 to 15/03/2018, with previous hospital stay less than 72h, with a likely ICU stay of at least 5 days were eligible for entering the study. The diagnosis of AKI was made according to KDIGO. Quadriceps rectus femoris and vastus intermedius thickness (QRFT and QVIT) were measured at the midpoint and at the border between the upper third and lower two-thirds between the anterior superior iliac spine (ASIS) and the upper pole of the patella. US was performed twice during ICU stay, i.e., at baseline (within 72h from admission) and after 5 days since the first measurement. Results We enrolled 30 patients, 70% (n= 21/30) were male, mean age ± SD age 74±11 years, APACHE II mean ± SD, 22 ± 5. Ultrasonography took less than 10 minutes to set up and complete image acquisition and less than 10 minutes per image to complete measurement analysis in all patients. A total of 472 images were analyzed across the 30 subjects.

Cold-water immersion (CWI) has become a popular preventive, regenerative and performance-enhancing intervention in various sports. However, its effects on soft tissue, including changes of intramuscular stiffness, are poorly understood. The purpose of this study was to investigate the effect of CWI on muscle stiffness. Thirty healthy participants were included and divided into the three following groups (n = 10): 1) post-ESU group: exercise and CWI (post-exercise set-up); 2) control group: exercise without CWI (control condition); 3) pre-ESU group: CWI alone (pre-exercise set-up). Acoustic radiation force impulse (ARFI) elastography was conducted to assess tissue stiffness (shear wave velocity, SWV). Values obtained at resting conditions (baseline, t0) were compared to values post-exercise (t1, for post-ESU group and control group), post-CWI (t2, for post-ESU group and pre-ESU group; rest for control group) and to 60-min follow-up time (t3, for all groups). Data were assessed in superficial and deep muscle tissue (rectus femoris muscle, RF; vastus intermedius muscle, VI). For the post-ESU group (CWI post-exercise), there was no significant difference between the time points of measurements: exercise (t1: RF: 1.63 m/s; VI: 1.54 m/s), CWI (t2: RF: 1.63 m/s; VI: 1.53 m/s) and at 60-min follow-up (t3: RF: 1.72 m/s; VI: 1.61 m/s). In the control group, a significant decrease of SWV was found between baseline conditions at t0 and post-exercise (t1) at VI (VI: 1.37 m/s; p = 0.004; RF: 1.59 m/s; p = 0.084). For t2 and t3, no further significant changes were detected. Regarding the pre-exercise set-up (pre-ESU group), a significant decrease in SWV from baseline to t2 in VI (1.60 m/s to 1.49 m/s; VI: p = 0.027) was found. This study shows varying influences of CWI on muscle stiffness. Overall, we did not detect any significant effects of CWI on muscle stiffness post-exercise. Muscle stiffness-related effects of CWI differ in the context of a pre- or post-exercise condition and have to be considered in the implementation of CWI to ensure its potential preventive and regenerative benefits. Die Kaltwasserimmersion (CWI) ist ein beliebtes präventives und regeneratives Therapieverfahren und hat sich in verschiedensten Sportarten etabliert. Die Effekte auf die Muskulatur sowie die Änderung der intramuskulären Gewebesteifigkeit sind jedoch ungeklärt. Ziel dieser Studie war es, den Einfluss einer Kaltwasserimmersionstherapie auf die Muskelsteifigkeit zu untersuchen. Insgesamt wurden 30 gesunde Athleten in 3 Gruppen (n = 10) aufgeteilt. 1) Post-ESU-Gruppe: Belastung und CWI; 2) Kontroll-Gruppe: Belastung ohne CWI; 3) Pre-ESU-Gruppe: CWI ohne Belastung. Die passive Muskelsteifigkeit wurde mittels Acoustic radiation force impulse (ARFI) Elasto-Sonografie anhand der Shear-Wave-Velocity (SWV) im M. rectus femoris (RF) und M. vastus intermedius (VI) bestimmt. Die Messwerte des Ausgangsniveaus (t0) wurden gruppenspezifisch mit den Werten nach der Belastung (t1, für Post-ESU-Gruppe und Kontroll-Gruppe) nach CWI (t2, für Post-ESU-Gruppe und Pre-ESU-Gruppe bzw. Kontrollzeit für Kontroll-Gruppe) und 60 min nach Intervention (t3, für alle Gruppen) verglichen. In der Post-ESU-Gruppe zeigte sich kein signifikanter Unterschied zwischen den Messzeitpunkten: Belastung (t1: RF: 1,63 m/s; VI: 1,54 m/s), CWI (t2: RF: 1,63 m/s; VI: 1,53 m/s;) und 60 min. nach Intervention (t3: RF: 1,72 m/s; VI: 1,61 m/s). In der Kontroll-Gruppe konnte eine signifikante Abnahme der SWV zwischen dem Ausgangsniveau t0 und t1 im VI beobachtet werden (VI: 1,37 m/s; p = 0,004) (RF: 1,59 m/s; p = 0,084). Zum Zeitpunkt t2 und t3 konnte keine weitere signifikante Änderung festgestellt werden. Eine signifikante Abnahme der SWV konnte in der Pre-ESU-Gruppe zwischen Ausgangsniveau (t0) und post-CWI (t2) im VI festgestellt werden (p = 0,027). Die vorliegende Studie zeigt unterschiedliche Einflüsse einer CWI auf die Muskelsteifigkeit. Insgesamt kann festgehalten werden, dass wir nach Belastung keinen signifikanten Effekt der CWI auf die Muskelsteife feststellen konnten. Die unterschiedlichen Effekte, abhängig vom Zustand vor oder nach Belastung, müssen bei der Durchführung bedacht werden, um einen möglichen präventiven und regenerativen Nutzen gewährleisten zu können.

Objective: The aim of this study was to investigate the effect of repetitive peripheral magnetic stimulation (rPMS) on muscle atrophy prevention in the rectus femoris muscle (RF) of the paretic limb in acute stroke patients. Methods: Twelve acute stroke patients with a National Institute of Health Stroke Scale score >5 and a motor score of the paretic lower limb >2 at admission were divided into an intervention group (rPMS: mean age, 75±6.4 years) and a conventional care group (non-rPMS: mean age, 62±11.8 years). Baseline measurements were performed within 4 days of stroke onset. In the rPMS group, treatment was applied to the paretic thigh only for 2 weeks, 5 days a week, in addition to conventional care. The cross-sectional area (CSA) of the RF was assessed in both limbs using ultrasound at baseline and 2 weeks later. Data on patient characteristics were collected from the clinical records to assess correlations with the CSA rate of change. Results: Patients in the rPMS group were significantly older. Although the CSA of the RF did not change significantly on either side in the rPMS group, there was a significant decrease in the CSA on the paretic side in the non-rPMS group. However, no significant difference was observed in the CSA rate of change in the rPMS and non-rPMS groups. The CSA rate of change on the paretic side correlated negatively with age in the rPMS group. Conclusions: Our results suggest that rPMS prevents muscle atrophy more effectively in patients in their 60s than in patients more than 70 years old.

A unique case is presented of a patient who is unable to fully hip extend in a rectus femoris muscle tear. Rectus femoris muscle is a type of quadriceps muscle, which is the most involved muscle in strain pathologies. Rectus femoris involves primarily in hip flexion and knee extension. We report a 23 year old young man who sustained injury to his right hip after a game of ‘sepak takraw’ whereby he fell on his right gluteus after a bicycle kick in the air. He sought medical attention immediately as he was unable to extend his hip and presented with a palpable painful mass over his right gluteal and proximal thigh region. This is the first reported case of rectus femoris tear presenting with failure of hip extension.

Highlights • Free tissue transfer is becoming the standard of care for lower extremity reconstruction. • Perforators of the descending branch of circumflex femoral artery based flaps can include the rectus femoris muscle flap. • Its a valid available option when more common cutaneous perforator is not available. • Its safe and easy to perform with great success., Introduction Free tissue transfer in children represents a good option for reconstruction in skilled hands despite the technical difficulties, and represent a significant challenge in microsurgery. With Anteriorlateral thigh flap is a popular option even in pediatric age group. Presentation of case We report here a case of 9 year old girl that sustained a lower extremity trauma with exposed ankle joint secondary to Motor Vehicle Crash, That was planned for (ALT) Anterior Lateral Thigh flap reconstruction, and was not completed and salvaged by rectus femoris flap as an alternative option on table to complete the reconstruction. Discussion Such case was successfully reconstructed by rectus femoris muscle free flap when ALT (Anterior lateral thigh) flap could not be completed as planned although it’s the workhorse flap in majority of cases, due to absence of perforator utilizing the same vascular anatomical blood supply with no significant donor site morbidity. Conclusion Based on this case report the rectus femoris flap was successfully performed, and we believe it’s an effective and reliable backup option to reconstruct complex lower extremity wound even in pediatric age group.

It is well known that several risk factors such as fatigue, previous injury, muscle strength deficit or imbalance are related to a higher incidence of knee injuries in professional soccer players. Knee muscle and tendon stiffness may be another factor that is related to knee injuries in professional soccer players. Therefore, the aim of the present study was to investigate the differences between professional soccer players and healthy sedentary males in terms of the stiffness of patellar tendon (PT), quadriceps tendon (QT), and rectus femoris muscle (RF) and vastus medialis muscle (VM).The study group was comprised of 17 professional male soccer players in age range of 24-37 years. The control group was comprised of 22 healthy sedentary males in an age range of 21-36 years. Shear-Wave Velocity (SWV) measurements of the selected muscles and tendons were performed using an ultrasonography device with a lineal probe.The professional soccer players had lower SWV of PT (P=0.024) and QT (P0.001) in the dominant leg compared to the control group; however, SWV of PT (P=0.455) and QT (P=0.827) in the non-dominant leg were similar in both groups. SWV of RF was higher in both dominant and non-dominant legs in professional soccer players compared to the control group (P0.05); however, SWV of VM was similar in both groups (P0.05).Professional soccer players had lower PT and QT stiffness. On the other hand, they had higher RF stiffness compared to sedentary individuals. Furthermore, VM stiffness was similar in both groups.

Background Rehabilitation according to Vojta is a neurophysiological method used to obtain reflex responses in muscles following stimulation of particular activation zones. Objectives This study aims to objectively evaluate the muscular responses following stimulation according to Vojta's method. The possible routes of spinal transmission responsible for the phenomenon of muscle activation in upper and lower extremities are considered. Methods Polyelectromyographic (pEMG) recordings in the upper and lower extremities in healthy volunteers (N = 25; aged 24 ± 1 year) were performed to find out the possible routes of spinal transmission, responsible for muscle activation. The left acromion and right femoral epicondyle were stimulated by a Vojta therapist; pEMG recordings were made including the bilateral deltoid and rectus femoris muscles. Results and discussion Following acromion stimulation, muscle activation was mostly expressed in the contralateral rectus femoris, rather than the contralateral deltoid and the ipsilateral rectus femoris muscles. After stimulation of the lower femoral epicondyle, the following order was observed: contra lateral deltoid, ipsilateral deltoid and the contra lateral rectus femoris muscle. One of the candidates responsible for the main crossed neural transmission involved in the Vojta therapy mechanism would be the long propriospinal tract neurons.

Introduction We investigated regional differences in amplitude modulation of the spinal reflex along the human rectus femoris (RF) muscle to test the hypothesis that this muscle is regionally regulated at the spinal cord or a higher level. Methods Surface electromyography was conducted at six different sites along the RF muscle during the conditioned patellar tendon reflex in eight healthy young men. Results A significant difference in the reflex amplitude among the channels was observed during 20% of the maximal voluntary contraction (MVC) and there was a significant difference in normalized reflex amplitude between 10 and 20% of the MVC at most proximal channel (p 0.05), during knee flexion of the ipsilateral leg. Discussion From the results in the present study, we infer that the amplitude modulation of the tendon reflex within the RF muscle is regionally regulated, and that this regulation is dependent on the performed tasks.

The importance of skeletal muscles in the development of osteoarthritis (OA) is known. However, in OA, strengthening the muscle is arduous process. This study investigated the effects of muscle enhancement and support therapy (MEST), a novel device for the intramuscular insertion of cog polydioxanone filament intended to hold and stimulate surrounding muscles, on OA-induced symptoms. In our results, the MEST attenuated OA-induced pain and mobility limitations, as evidenced by increases in withdrawal thresholds, rearing duration and travelled distance in an open cage, and fall latency from rotarod. It further restored atrophic rectus femoris muscle (RFM) in OA animals by increasing mass, decreasing nucleus density, and increasing the cross-sectional area of muscle fibers. Decreased collagen and insulin-like growth factor 1 levels in OA animals were restored without affecting the interleukin-6 and tumor necrosis factor-alpha levels in RFM. No evidence of structural improvement in the knee was observed via computed tomography after MEST. These results suggest that MEST in the quadriceps is effective for relieving pain and motor impairment in knee OA animals by restoring atrophic muscles, providing a novel therapeutic strategy for OA symptom management.

Research Objectives To study the relationship between changes in muscle ultrasound parameters of the rectus femoris and functional outcomes of patients with incomplete spinal cord injury after inpatient rehabilitation. Design Prospective cohort study. Setting Tertiary rehabilitation center. Participants 40 consecutive patients with incomplete spinal cord injury. Interventions An initial ultrasound assessment was performed within 2 weeks of injury, and a follow-up assessment was performed at 4 weeks. Ultrasound measurements were performed using B-mode ultrasound scanning and standardized protocols. Main Outcome Measures Lower extremity muscle score (LEMS), functional independence measure (FIM), Walking Index for Spinal Cord Injury II (WISCI II). Results 40 patients were recruited, with a mean age of 60.0 (SD=16.7) years. An increase in rectus femoris muscle thickness was significantly related with increased LEMS (Spearman's rho = 0.448), increased FIM motor subscores (Spearman's rho = 0.595) and increased WISCII scores (Spearman's rho = 0.531) on discharge. An increase in rectus femoris echo intensity was also significantly related with reduced LEMS (Spearman's rho = -0.345), reduced FIM motor subscores (Spearman's rho = -0.413) and reduced WISCII scores (Spearman's rho = -0.355) on discharge. Conclusions We report that a relationship exists between muscle ultrasound parameters of the rectus femoris and ambulatory outcomes after inpatient rehabilitation. These findings are potentially useful in understanding the role of muscle in functional recovery. Author(s) Disclosures None.

Shunt migration is a rare complication of ventriculoperitoneal (VP) shunts in the treatment of hydrocephalus. This case highlights the migration of a VP shunt through the abdominal wall into the rectus femoris muscle of a 4-year-old girl. The malpositioned shunt was initially visualized in the thigh on an x-ray shunt series for an enteritis work up. It was subsequently visualized on CT scan during an evaluation for appendicitis. Seven months following the initial visualization and 2 months following an appendectomy, the patient presented with symptoms of swelling and pain in the anterior thigh, which prompted laparoscopic repositioning of the shunt. The patient recovered and did not experience additional symptoms of hydrocephalus or shunt migration. The case presented in this article highlights the roles of imaging and laparoscopic surgery in diagnosing shut migration. Keywords: Ventriculoperitoneal shunt, Shunt migration, Displaced shunt

Introduction The anteromedial thigh flap (AMT) lies adjacent to the anterolateral thigh flap (ALT) area and can be used as a backup whenever the ALT is not feasible. Literature published on the AMT flap is limited, and the vascular anatomy of the AMT flap is not well understood. Clarification of the vascular anatomy will be useful for safe and efficient planning and raising of the AMT flap. Method Fourteen cadaveric lower limbs were injected with latex dye and dissected to study the skin perforators larger than 0.5 mm in the anterolateral and anteromedial thigh. We demonstrate the application of the AMT flap in a clinical case where a combined ALT and AMT flap was used to reconstruct a tongue and floor of mouth defect post cancer resection. Results Perforators that supplied the rectus femoris muscle and the overlying skin were present in all specimens and 12/14 (85.7%) specimens had rectus femoris branches (RFBs) originating from the descending branch of the lateral circumflex iliac artery. In total, 82.4% of AMT perforators are musculocutaneous (14/17 specimens), and they pierce the muscular fascia along a line drawn from the mid-inguinal point to the superomedial pole of the patella. The perforators congregate at the one-quarter mark and the midpoint of this line. This line is useful for the preoperative planning of the AMT flap. Conclusion The anatomy of the RFB, which is critical in the blood supply of the AMT flap, is constant and predictable. The location of the perforators is predictable, which aids preoperative planning.

Skeletal traction is performed to temporarily stabilize fracture sites before surgery in patients with femoral fracture. To date, however, there is no study evaluating the difference in the degree of the recovery, of the muscle strength, as well as muscle atrophy following skeletal traction. The purpose of this study was to compare the degree of recovery of rectus femoris muscle strength after surgery in association with muscle atrophy by analyzing the duration of preoperative tibial traction, age and sex in patients with femoral fracture.Rectus femoris muscle atrophy will progress depending on the duration of preoperative tibial traction, age and sex in patients with femoral fracture.Thirty-one patients who underwent preoperative pretibial skeletal traction and intramedullary nailing were divided into two groups according to the traction period: group A (n=12) with a duration of traction of7 days (mean: 4.08±1.78 days) and group B (n=19) ≥7 days (mean: 13.63±7.17 days). The degree of muscle atrophy and recovery were compared between the two groups, according to age and gender. The degree of muscle atrophy was measured by the difference in thickness of the rectus femoris between pre- and post-traction using ultrasound. The degree of muscle recovery was evaluated by the Q-setting and heel off time. Clinical outcome was evaluated by the non-union rate and Lysholm score.The degree of muscle atrophy was 0.99±0.14mm in group A and 2.22±0.11mm in group B (P0.001). The Q-setting time was 4.83±0.94 days in group A and 6.56±1.38 days in group B (P=0.001). Heel off time was also shorter in group A at 2.58±0.90 days, taking 3.72±1.27 days in group B (P=0.012). The recovery rate in the rectus femoris was significantly higher in group A than in group B (P0.001). There was no significant difference in non-union rate between group A and B (P=0.672) but the mean Lysholm score at the last follow-up was significantly higher in group A than in group B (P=0.006). However, no significant differences were detected in the mean thickness of the rectus femoris, Q-setting, and heel off time between the different age and gender groups (P0.05).The prolonged duration of preoperative skeletal traction indicates not only that the resulting disuse atrophy would progress further but also that the muscle atrophy would be accelerated more rapidly for shorter periods of time, based on a cut-off value of 7 days. In addition, the rate of rectus femoris muscle recovery and clinical outcomes were lower in patients undergoing traction for longer periods of time. This indicates that it would be effective for increasing the rate of the recovery and minimizing the occurrence of post surgical complications if surgeons could perform surgery at the earliest possible opportunity following traction, within seven days after the onset of trauma.IV, retrospective cohort study.

Rectus femoris muscle proximal injuries are not rare conditions. The proximal rectus femoris tendinous anatomy is complex and may be affected by traumatic, microtraumatic, or nontraumatic disorders. A good knowledge of the proximal rectus femoris anatomy allows a better understanding of injury and disorder patterns. A new sonographic lateral approach was recently described to assess the indirect head of the proximal rectus femoris, hence allowing for a complete sonographic assessment of the proximal rectus femoris tendons. This article will review sonographic features of direct, indirect, and conjoined rectus femoris tendon disorders.

International audience; PurposeThis study aimed to determine the acute effects of static stretching on stiffness indexes of two muscle groups with a contrasting difference in muscle–tendon proportion.MethodsEleven active males were tested on an isokinetic dynamometer during four sessions randomly presented. Two sessions were dedicated to quadriceps and the two others to triceps surae muscles. Before and immediately after the stretching procedure (5 × 30 s), gastrocnemius medialis and rectus femoris fascicle length and myotendinous junction elongation were determined using ultrasonography. Passive and maximal voluntary torques were measured. Fascicle and myotendinous junction stiffness indexes were calculated.ResultsAfter stretching, maximal voluntary torque similarly decreased for both muscle groups. Passive torque significantly decreased on triceps surae and remained unchanged on quadriceps muscles. Fascicle length increased similarly for both muscles. However, myotendinous junction elongation remained unchanged for gastrocnemius medialis and increased significantly for rectus femoris muscle. Fascicle stiffness index significantly decreased on medial gastrocnemius and remained unchanged on rectus femoris muscle. In contrast, myotendinous junction stiffness index similarly decreased on both muscles.ConclusionDepending on the muscle considered, the present results revealed different acute stretching effects. This muscle dependency appeared to affect primarily fascicle stiffness index rather than the myotendinous junction.

Objectives The purpose of this study was to determine intraobserver, interobserver, and inter-day reliability levels for stiffness measurements of the patellar tendon and rectus femoris muscle using shear wave elastography (SWE). Methods This study was conducted on 12 healthy male individuals. Two examiners measured mean shear wave velocity values of the patellar tendons and rectus femoris muscles of both extremities using a 9L4 (4-9 MHz) transducer and an Acuson S3000 ultrasound system (Siemens Medical Solutions, Mountain View, CA). The elasticity images were acquired by the Virtual Touch tissue imaging quantification technique (Siemens Medical Solutions). Measurements were repeated 20 minutes and 1 week after the first measurements. The reliability of SWE measurements was assessed by means of the intraclass correlation coefficient (ICC). Results The 12 participants ranged in age from 19 to 33 years (mean age ± SD, 25.33 ± 4.56 years). For the patellar tendon stiffness measurements with SWE, it was found that intraobserver reliability (ICC, 0.91–0.92) and interday reliability (ICC, 0.81–0.83) were excellent, and interobserver reliability (ICC, 0.71) was good. For the rectus femoris muscle stiffness measurements with SWE, it was found that the intraobserver reliability (ICC, 0.93–0.94), interday reliability (ICC, 0.81–0.91), and interobserver reliability (ICC, 0.95) were perfect. Conclusions Shear wave elastography using the Virtual Touch tissue imaging quantification technique is a reliable and repeatable technique for patellar tendon and rectus femoris stiffness measurements according to intraobserver, interday, and interobserver ICC values.

Introduction We explored the conditioning effect of a percutaneous electrical pulse of the femoral nerve on cortical motor evoked responses in the rectus femoris muscle. Methods Corticospinal excitability of rectus femoris muscle was measured in sixteen healthy subjects, when a single transcranial magnetic pulse was preceded by an electrical femoral nerve stimulus, using twelve inter-stimulus intervals (from 10 to 275 ms). We also evaluated the effects of the intensities of the transcranial magnetic and of the electrical pulses. Results Quadriceps motor evoked potentials were inhibited and facilitated when a single femoral nerve electrical stimulus was delivered at inter-stimulus intervals of 25 ms and 150 ms, respectively. The facilitation was reduced when low electrical intensity was used, while the inhibition decreased with high intensity transcranial magnetic pulse. Conclusion Afferent inputs of a femoral stimulation modulate the responses elicited by transcranial magnetic pulses of the contralateral quadriceps motor cortex. This modulation indicates a sensorimotor integration of proximal lower limb muscles that may be mediated via different types of afferents. This could be of relevance for studies that explore the role of lower limb muscles in postural control and balance.

[Purpose] This study aims to investigate the effects of exercise using an ergometer with swaying saddle on chronic lower back pain. [Subjects and Methods] Thirty-three normal adults (university students) with chronic lower back pain were randomly recruited. The flexibility and strength of muscles were measured before and after an 8-week intervention. Belly-bike, an ergometer with a swaying saddle, was used. The duration of intervention was 30 minutes a day, 3 times a week. To measure the level of pain, visual analogue scale (VAS) and Korean Oswestry Disability Index were used. In addition, flexibility tests such as straight leg raising and forward reaching test in the long sitting posture were used to confirm back muscle shortness. Activations of the erector spinae muscle, gluteus medius muscle, rectus femoris muscle, and vastus lateralis muscle were also measured by electromyography before and after the intervention. Electromyography of muscles around the pelvis was performed and functional tests were conducted. [Results] The flexibility and strength of the muscles significantly increased post-intervention. Functional test scores for the forward reaching test and straight leg raising test significantly improved in the Belly-bike group. [Conclusion] The results show that exercise using the Belly-bike could be effective in reducing lower back pain.