自基线至前交叉韧带重建术后12个月期间使用自体股四头肌腱移植物患者下肢肌肉体积不对称性的变化
简介
该研究纳入25例接受股四头肌腱自体移植物ACL重建的患者，术前及术后3、12个月行双侧下肢MRI，采用自动分割算法测量34块肌肉体积，评估不对称性及纵向变化。关键发现：术前6/34（17.6%）肌肉存在显著缺损，术后3个月增至16/34（47.1%），12个月仍有10/34（29.4%）。股内侧肌和股外侧肌萎缩最显著且持续（12个月SMD 0.9），腓肠肌萎…
英文摘要
BACKGROUND: Recovery of quadriceps muscle volume and function is a primary rehabilitation focus after anterior cruciate ligament reconstruction (ACLR). However, limited evidence exists on the recovery of other lower extremity muscles. Early activity limitations and persistent postoperative biomechanical alterations may contribute to volume changes in lower extremity muscles. PURPOSE/HYPOTHESIS: The purpose of this study was to characterize lower extremity muscle volume changes from preoperative baseline to 12 months post-ACLR. It was hypothesized that the quadriceps would show the largest, most persistent atrophy. It was further hypothesized that other muscles would show atrophy early post-ACLR but that most would recover to preoperative levels by 12 months except for the gastrocnemii, which have previously demonstrated long-term atrophy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 25 patients (mean age, 26.8 ± 9.0; 52% female) undergoing ACLR with quadriceps tendon autograft had bilateral lower extremity magnetic resonance imaging scans within 9 days prior to ACLR as well as 3 and 12 months post-ACLR. Muscle volumes for 34 bilateral muscles were determined using an automated segmentation algorithm. Volume was normalized to height-mass product. Standardized mean differences (SMDs) and paired t tests assessed between-limb asymmetries. Linear mixed-effects models with a fixed effect of time and random effect for patient assessed longitudinal changes. RESULTS: Significant operative limb deficits were present in 6 of 34 (17.6%) muscles preoperatively, 16 of 34 (47.1%) at 3 months, and 10 of 34 (29.4%) at 12 months. Vasti deficits were the most pronounced and persistent (SMD: preoperative, 0.4-0.6; 3 months, 1.1-1.2; 12 months, 0.9; all P < .03). Significant deficits also persisted in the gastrocnemii (SMD: 0.4-0.5 at 12 months; P < .03). The gluteus maximus of the operative limb was significantly larger at 12 months (SMD: 0.18; P = .045). CONCLUSION: Operative limb muscle volume deficits were greatest at 3 months post-ACLR. Significant deficits of the quadriceps and gastrocnemii persisted at 12 months post-ACLR, while the operative limb gluteus maximus was larger than the nonoperative limb at 12 months.