Rotura traumática simultánea y bilateral del tendón del cuádriceps en un paciente fisicoculturista: informe de caso y revisión de la literatura / Simultaneous bilateral traumatic quadriceps tendon rupture in a bodybuilding patient: case report and literature review

La rotura traumática, simultánea y bilateral del tendón cuadricipital es una lesión infrecuente, generalmente asociada a otras enfermedades sistémicas tales como insuficiencia renal o trastornos endocrinos. Presentamos el caso de un varón sano y atleta de 38 años que sufrió esta lesión mientras realizaba una sentadilla en el gimnasio. (AU)

The traumatic bilateral and simultaneous quadriceps tendon rupture is a rare injury, usually associated with other systemic diseases such as renal insufficiency or endocrine disorders. We present the case of a 38-year-old healthy male athlete who sustained this injury while performing a squat at the gym. (AU)

Reliability on evaluation of quadriceps femoris muscle quality by ultrasonic echo intensity in patients with knee osteoarthritis / 中国康复理论与实践

ObjectiveTo evaluate the inter-rater and test-retest reliability of echo intensity of ultrasound image for quality of quadriceps femoris in patients with knee osteoarthritis (KOA). MethodsFrom March to December, 2021, 33 patients with unilateral KOA in Guangdong Provincial Second Hospital of Traditional Chinese Medicine were included. Ultrasound was used to observe the cross sections of rectus femoris (RF), vastus medialis (VM) and vastus lateralis (VL), and the images were saved. Two independent raters analyzed the average gray value of the picture with the Image J. One of the raters repeated the measurement. The intra-class correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MDC) and coefficient of variation (CV) were calculated and the Bland-Altman charts were drawn. ResultsThe gray value was higher in the RF, VM and VL in the affected side than in the healthy side (t > 2.262, P < 0.05). The inter-rater reliability was excellent, with ICC 0.982 to 0.995, SEM 1.60 to 3.82, CV 1.49% to 5.90%, and MDC value 4.43 to 10.59. The test-retest reliability of the rater was excellent, with ICC 0.969 to 0.990, SEM 2.37 to 5.41, CV 2.22% to 4.84%, and MDC value 6.57 to 15.00. Bland-Altman charts analysis showed that the consistency was good. ConclusionThe quadriceps femoris muscle quality is different between the affected and the healthy sides in patients with unilateral KOA. It is reliable to evaluate muscle echo intensity by Image J.

Surface electromyography of lower limb muscles in healthy middle-aged and old women during stair ascent and descent / 中国康复理论与实践

ObjectiveTo observe the lower limb muscle activation strategy of healthy middle-aged and old women during stair ascent and descent with surface electromyography. MethodsFrom August, 2021 to February, 2022, 20 healthy middle-aged and old women were measured the surface electromyography root mean square (RMS) and integrated electromyography (iEMG) of bilateral vastus lateral, rectus femoris, vastus medialis, biceps femoris and semitendinosus during stair ascent and descent, and co-contraction ratio was calculated. ResultsDuring stair ascent, the RMS of bilateral vastus lateral, rectus femoris and vastus medialis was higher at starting stage than at following stage (|t| > 6.650, P < 0.001), while the RMS of biceps femoris and semitendinosus was lower (t > 3.559, P < 0.01); and the co-contraction ratio of hamstrings/quadriceps was lower at starting stage than at following stage (t > 8.185, P < 0.001). During stair descent, the RMS of bilateral vastus lateral, vastus medialis, biceps femoris and semitendinosus was higher at following stage than at starting stage (t > 2.345, P < 0.05), as well as the co-contraction ratio of hamstrings/quadriceps (t > 2.405, P < 0.05). ConclusionThe activities of the muscles around the knees are almost symmetrical during stair ascent and descent for healthy middle-aged and old women. The activation and co-contraction ratio of quadriceps and hamstring are various at starting/following stages.

The effects of blood flow restriction on the quadriceps femoris and knee stability after anterior cruciate ligament reconstruction / 中华物理医学与康复杂志

Objective:To explore the effect of blood flow restriction training on the quadriceps femoris and on knee stability after anterior cruciate ligament reconstruction.Methods:Forty patients recovering from anterior cruciate ligament reconstruction were randomly divided into an experimental group and a control group, each of 20. In addition to routine rehabilitation training, the control group was given routine knee flexion and extension strength training, while the experimental group trained for an additional 20 minutes doing knee flexion and extension resistance training with the blood pressure in their groins at 70% of their individual arterial occlusive pressure. (The mean pressure was (123±11.23)mmHg). The training lasted 8 weeks, three times a week. Knee function and hamstring and quadriceps peak torque were assessed before and after the intervention using a Lysholm scale and Humac Norm isokinetic muscle strength tests.Results:There were no significant differences between the two groups in any of the measurements before the training. After the intervention, all of the measurements had improved significantly in both groups, with the average Lysholm score, H/Q% and peak torque of the experimental group significantly better than the control group′s averages.Conclusions:Blood flow restriction training can improve the effectiveness of quadriceps femoris strength, knee stability and knee function training after anterior cruciate ligament reconstruction.

Effect of electrical stimulation on oxidative stress in tissues in a rat model with incision wound

Electrical stimulation (ES) are known to have beneficial effects in wound healing. However, the effect of electrical stimulation in wound theraphy on the oxidant and antioxidant levels of various tissues in the body remains unclear. Here, we investigated the effects of electrical stimulation on the oxidative stress capacity of tissues in a rat model with a surgical incision wound on the lateral line of the femoral region. Rats divided in two groups: control and ES group. A longitudinal skin incision was made only from the right lateral line of all rats. ES was applied 200 ?s, 20 Hz, 2mA for 20 min during 15 days. Some oxidative stress parameters (malondialdehyde (MDA), reduced glutathione (rGSH), glucose-6-phosphate dehydrogenase (G6PD), glutathione peroxidase (GPx) and catalase (CAT)) in tissues (brain, heart, kidney, liver, testis, gastrocnemius and quadriceps femoris muscle) were obtained spectrophotometrically. The ES reduced oxidative stress by decreasing MDA and simultaneously increasing different antioxidants in different tissues. The results suggest that incision wound could induce oxidative stress in tissues and electrical stimulation post-incision wound may have ameliorative effect.

Análisis biomecánico de la continuación prepatelar del cuádriceps / Biomechanical assessment of the prepatellar quadriceps continuation

OBJETIVO Determinar la resistencia máxima a la tracción (RMT) de la continuación prepatelar del cuádriceps (CPC).MATERIALES Y MÉTODOS Se realizó un estudio en cadáveres humanos. Fueron incluidos diez especímenes, en los cuales se utilizaron los tercios proximal y medial de la cortical anterior de la patela para evaluar las propiedades mecánicas de la CPC. En cada espécimen, se estudió un área de sección transversal de 0,2 cm2 (A1) y 1 cm2 (A2). Se aplicó una carga gradual para determinar la RMT.RESULTADOS La mediana de la RMT en el A1 fue de 232,56 N (rango: 141,23 N a 295,33 N) y en el A2 fue de 335,30 N (rango: 216,45 N a 371,40 N). El incremento en la TMR fue significativo entre las 2 áreas (p = 0,006).CONCLUSIÓN El ignificado clínico de este estudio es que la CPC es un tejido fuerte que puede servir de anclaje seguro para reconstrucciones alrededor de la patela. Un área relativamente pequeña tolera al menos 140 N y, a medida que crece el área, también aumenta la RMT.

OBJETIVE To determine the ultimate tensile strength (UTS) of the prepatellar quadriceps continuation (PQC). MATERIALS AND METHODS A human cadaveric study was performed. Ten fresh-frozen specimens were used. The proximal and medial thirds of the anterior cortex of the patella were used to assess the mechanical properties of the PQC. In each specimen, transverse section areas measuring 0.2 cm2 (A1) and 1 cm2 (A2) were studied. A gradual load was applied to determine the UTS. RESULTS The median UTS of A1 was of 232.56 N (range: 141.23 N to 295.33 N), and that of A2 was of 335.30 N (range: 216.45 N to 371.40 N). The increment in UTS was significant between the 2 areas (p » 0.006). CONCLUSION The clinical significance of the present study lies in the fact that it shows that the PQC is a strong tissue that can be a safe anchor for reconstruction around the patella. A relatively small area supports at least 140 N, and, as the area grows, the UTS increases as well.

Diagnostic value of early bedside ultrasound measurement of quadriceps femoris on in-hospital mortality of septic patients / 中华危重病急救医学

Objective:To investigate the changes of quadriceps femoris thickness with the length of stay in intensive care unit (ICU) in patients with sepsis, and to evaluate the diagnostic value of muscle changes in mortality.Methods:A prospective study was conducted, and 92 patients with sepsis who were admitted to the ICU of the Affiliated Hospital of Jining Medical College from January 2020 to December 2021 were enrolled. The thickness of quadriceps femoris [including the quadriceps femoris muscle thickness at the midpoint of the anterior superior iliac spine and the upper edge of the patella (M-QMLT), and at the middle and lower 1/3 of the patella (T-QMLT)] measured by ultrasound 1 day (D1), 3 days (D3), and 7 days (D7) after admission to the ICU were collected. The atrophy rate of quadriceps femoris was calculated 3 and 7 days after admission to the ICU compared with 1 day [(D3-D1)/D1 and (D7-D1)/D1, (TD3-TD1)/TD1 and (TD7-TD1)/TD1, respectively]. The demographic information, underlying diseases, vital signs when admission to the ICU and in-hospital mortality of all patients were recorded, and the differences of the above indicators between the two groupswere compared. Multivariate Logistic regression was used to analyze the influence of quadriceps femoris muscle thickness and atrophy rate on in-hospital mortality of septic patients. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of quadriceps femoris muscle thickness and atrophy rate on in-hospital mortality of septic patients.Results:A total of 92 patients with severe sepsis were included, of which 41 patients died in hospital, 51 patients discharged. The in-hospital mortality was 44.6%. The muscle thickness of quadriceps femoris in severe septic patients decreased with the prolongation of ICU stay, and there was no significant difference between the two groups at the first and third day of ICU admission. The muscle thickness of quadriceps femoris at different measuring positions in the survival group was significantly greater than those in the death group 7 days after admission to the ICU [M-QMLT D7 (cm): 0.50±0.26 vs. 0.39±0.19, T-QMLT D7 (cm): 0.58±0.29 vs. 0.45±0.21, both P < 0.05]. The atrophy rate of quadriceps femoris muscle thickness at different measuring positions 3 and 7 days after admission to ICU in the survival group was significantly lower than those in the death group [(D3-D1)/D1: (8.33±3.44)% vs. (9.74±3.91)%, (D7-D1)/D1: (12.21±4.76)% vs. (19.80±6.15)%, (TD3-TD1)/TD1: (7.83±4.26)% vs. (10.51±4.75)%, (TD7-TD1)/TD1: (11.10±5.46)% vs. (20.22±6.05)%, all P < 0.05]. Multivariate Logistic regression analysis showed that M-QMLT D7, T-QMLT D7, (D3-D1)/D1, (D7-D1)/D1, (TD3-TD1)/TD1, (TD7-TD1)/TD1 were independent risk factors for in-hospital mortality (all P < 0.05). The results were stable after adjusting for confounding factors. ROC curve analysis showed that (TD7-TD1)/TD1 [area under the ROC curve (AUC) was 0.853, 95% confidence interval (95% CI) was 0.773-0.934] was superior to (D7-D1)/D1, T-QMLT D7, M-QMLT D7, (TD3-TD1)/TD1 and (D3-D1)/D1 [AUC was 0.821 (0.725-0.917), 0.692 (0.582-0.802), 0.683 (0.573-0.794), 0.680 (0.569-0.791), 0.622 (0.502-0.742)]. Conclusions:For septic patients in ICU, bedside ultrasound monitoring of quadriceps femoris muscle thickness and atrophy rate has a certain predictive value for in-hospital mortality, and a certain guiding significance in clinical treatment and predicting the prognosis of sepsis.

Isokinetic muscle strength of knee for patients with chondromalacia patellae / 中国康复理论与实践

@#Objective To analyze the characteristics of the muscle strength around the knee joint of chondromalacia patellae patients, and to explore the difference with normal people.Methods In March, 2021, 70 knee-onset chondromalacia patellae patients (experimental group) and 35 normal people (control group) were measured isokinetic muscle strength of flexion and extension of knee in angular velocities of 60°/s and 180°/s.Results At 60°/s and 180°/s, the peak torque, the peak torque-to-weight ratio and the total work of the flexor and extensor muscles on the affected side in the experimental group were lower than that of the control group (U > 1097.0, P<0.001). The peak torque, the peak torque-to-weight ratio and the total work of the flexor and extensor muscles at 60°/s and extensor muscles at 180°/s were lower on the affected side than on the healthy side in the experimental group (|Z| > 2.121, P<0.05). The peak torque ratios at 60°/s and 180°/s were more in the affected knees than in the healthy knees of experimental group and in the control group (U > 1810.0, |Z| >3.691, P<0.01).Conclusion The explosive force and endurance of the knee flexor and extensor has weakened in patients with chondromalacia patellae, and there is imbalance in knee joint muscle strength.

Grafts for anterior cruciate ligament reconstruction: systematic review and meta-analysis / Enxertos para reconstrução do ligamento cruzado anterior: revisão sistemática e metanálise

ABSTRACT Objective: This study proposes to systematically review the literature and compare data on (1) function, (2) pain, (3) return to sport, and (4) complications after anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft (QT) and hamstring tendon autograft (HT). Methods: In June 2021, a systematic review of the EMBASE, MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, and LILACS databases was performed, based on PRISMA guidelines. The search strategy included the keywords: "Previous Cruciate Ligament Reconstruction," "ACL reconstruction," "quadriceps tendon autograft," "quadriceps graft," "Hamstring-Tendon Autografts." Meta-analyses were performed using Review Manager software (RevMan Web). Results: There were no significant differences between the two groups regarding function according to Lysholm score (MD 3.01; CI-0.30, 6.33, p = 0.08), the presence of pain (RR 0.89; CI-0.57, 1.39, p = 0.60), and re-rupture (RR 0.60; IC-0.19, 1.88, p = 0.38). Conclusion: QT and HT autografts show comparatively good results in ACL reconstruction without significant differences regarding function, pain, and rupture after surgical intervention. Level of Evidence II, Systematic Review of Level II Studies.

RESUMO Objetivo: Revisar sistematicamente a literatura e comparar dados sobre função, dor, retorno ao esporte e complicação após a reconstrução de ligamento cruzado anterior (LCA) com autoenxerto do tendão do quadríceps (TQ) e autoenxerto do tendão dos músculos isquiotibiais (TF). Métodos: Em junho de 2021, foi realizada revisão sistemática das bases de dados EMBASE, MEDLINE/PubMed, Cochrane Central Register of Controlled Trials e LILACS, baseada nas diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A estratégia de pesquisa incluiu as palavras-chave: "Anterior Cruciate Ligament Reconstruction", "ACL reconstruction", "quadriceps tendon autograft", "quadriceps graft" e "Hamstring-Tendon Autografts". As metanálises foram realizadas usando o software Review Manager (RevMan Web). Resultados: Não houve diferenças significativas entre os dois grupos com relação à função pelo escore de Lysholm (MD 3,01; IC-0,30, 6,33, p = 0,08), presença de dor (RR 0,89; IC-0,57, 1,39, p = 0,60) e re-ruptura (RR 0,60; IC-0,19, 1,88, p = 0,38). Conclusão: Os autoenxertos de TQ e TF apresentam resultados comparativamente bons na reconstrução do LCA sem diferenças significativas com relação à função, dor e ruptura após a intervenção cirúrgica. Nível de Evidência II, Revisão Sistemática de Estudos de Nível II.

Lateral and functional asymmetries in the lower limbs of college-level female handball players

Abstract Aim: The present study aimed to screen for differences in isokinetic peak torque, hamstrings-to-quadriceps ratio, and proprioception within the lower limbs of female handball athletes. Methods: Twelve college-level female handball athletes with no previous experience with resistance training performed five maximal isokinetic contractions of the knee extensors and knee flexors to determine isokinetic peak torque and hamstring-to-quadriceps ratios. Proprioception was determined by assessing passive position sense on an isokinetic dynamometer. Results: The athletes presented significantly greater (p < 0.01) knee extensors isometric peak torque for the jumping limb (144.9 ± 23.1) when compared to the non-jumping limb (132.9 ± 21.5). The Hamstrings-to-quadriceps ratio was below 0.6 for both limbs, being significantly greater (p < 0.01) for the non-jumping limb (0.56 ± 0.08) when compared to the jumping limb (0.50 ± 0.08). Conclusion: Female handball athletes that do not engage in resistance training can experience functional bilateral asymmetries in the knee extensors and knee-joint instability, as assessed by the hamstrings-to-quadriceps ratio due to the asymmetric characteristics of handball. Regular strength training might correct such asymmetries and instabilities.

Treatment of quadriceps tendon rupture in hemodialysis patients: a 2020 update / Tratamento da ruptura do tendão do quadríceps em hemodialisados: uma atualização em 2020

ABSTRACT Quadriceps tendon tears are uncommon injuries often associated with chronic diseases, including end-stage renal disease (ESRD). The role of secondary hyperparathyroidism as a predisposing factor for tendon tears in this group of patients is well documented, and the weakening of the tendon-bone junction is part of this context. The treatment of choice for quadriceps tendon ruptures in patients with ESRD is surgery, which should be performed as soon as possible. There are several surgical techniques to be used, but the lack of comparative studies does not allow us to conclude which one is the best option. More recent publications have preferred the association of techniques, with emphasis on the use of autologous tendon grafts as a reinforcement tool, which is the author's procedure of choice. Recent studies reported the use of biological agents to stimulate healing and allografts, but the information seems preliminary to be routinely recommended. Level of evidence II; Obsevation of therapeutic studies.

RESUMO As rupturas do tendão do quadríceps são lesões incomuns, frequentemente associadas a doenças crônicas, incluindo a doença renal em estágio de falência funcional. O papel do hiperparatireoidismo secundário como fator predisponente para rupturas tendinosas nesse grupo de pacientes está bem documentado, e o enfraquecimento da junção tendão-osso faz parte desse contexto. O tratamento de escolha para rupturas do tendão do quadríceps em pacientes com falência renal é a cirurgia, e deve ser realizado o mais rápido possível. Existem várias técnicas cirúrgicas a serem utilizadas, mas a falta de estudos comparativos não nos permite concluir qual é a melhor opção. Publicações mais recentes têm preferido a associação de técnicas, com destaque para o uso de enxerto tendíneo autólogo como ferramenta de reforço, procedimento de escolha do autor. Estudos recentes relatam o uso de agentes biológicos para estimular a cicatrização e aloenxertos, mas as informações parecem preliminares para serem rotineiramente recomendadas. Nível de Evidência II; Observação de estudos terapêuticos.

Muscle architecture of the vastus lateralis and rectus femoris in the production of knee extensor torque in physically inactive women

Abstract Aim: This study aimed to verify the data reliability of muscle architecture (MA) variables, and the relationship between MA and the isometric peak torque (PT) of the monoarticular and biarticular knee extensor (KE) muscle in physically inactive women. Methods: Ten physically inactive women (24.0 ± 1.64 years; 162.9 ± 5.34 cm; 63.5 ± 11.90 kg) participated in the study. An ultrasound device assessed the MA variables (muscle thickness, fascicle length, and pennation angle) of the Vastus Lateralis (VL) and Rectus Femoris (RF), and an isokinetic dynamometer assessed the PT. Pearson correlation evaluated the relationship between PT and MA variables, with a significance level of 5%. Additionally, the intraclass correlation coefficient, coefficient of variation, and standard error of measurement. Results: Excellent reliability between images was observed, and no significant relationships were observed between the PT and MA variables of the VL and RF. Conclusion: Isolated variables of the MA of a monoarticular or a biarticular muscle do not influence the production of the isometric PT of the KE.

Effect of fatigue on explosive strength and muscle architecture of the vastus lateralis / Efecto de la fatiga sobre la fuerza explosiva y la arquitectura muscular del vasto lateral / Efeito da fadiga na força explosiva e arquitetura muscular do vasto lateral

ABSTRACT Introduction: There has been little research on changes in rate of torque development (RTD) and muscle architecture. This study evaluated the effect of fatigue on RTD and muscle architecture of the vastus lateralis (VL). Methods: Seventeen volunteers (25.5 ± 6.2 years; 177.2 ± 12.9 cm; 76.4 ± 13.1 kg) underwent isokinetic knee extension assessment at 30°/s to obtain the peak torque (PT-ISK), before and after a set of intermittent maximal voluntary isometric contractions (MVIC) (15 reps - 3 s contraction, 3 s rest) used to promote muscle fatigue, monitored by the median frequency (MDF) of the electromyography from the VL, rectus femoris and vastus medialis muscles. Before and after the fatigue protocol, ultrasound images of the VL were obtained to measure muscle thickness (MT), fascicle length (FL), and fascicle angle (FA). The peak isometric torque (PT-ISM) and the RTDs in 50 ms windows were calculated for each MVIC. The RTDs were reported as absolute values and normalized by the PT-ISM. Results: Fatigue was confirmed due to significant reductions in MDF in all three muscles. After the fatigue protocol, the PT-ISK was reduced from 239.0±47.91 to 177.3±34.96 Nm, and the PT-MVIC was reduced from 269.5±45.63 to 220.49±46.94 Nm. All the RTD absolute values presented significant change after the fatigue protocol. However, the normalized RTD did not demonstrate any significant differences. No significant differences were found in the muscle architecture of the VL. Conclusions: The reduction in explosive strength occurred concomitantly with the reduction in maximum strength, as evidenced by the lack of changes in normalized TDT. Level of Evidence III.

RESUMEN Introducción: Los cambios en la tasa de desarrollo del torque (TDT) y la arquitectura muscular causada por la fatiga son temas poco investigados. Esta investigación evaluó el efecto de la fatiga en la TDT y la arquitectura muscular del vasto lateral (VL). Métodos: 17 voluntarios (25.5 ± 6.2 años; 177.2 ± 12.9 cm; 76.4 ± 13.1 kg) se sometieron a una evaluación isocinética de la extensión de la rodilla a 30º/s para obtener el pico de torque (PT-ISK), antes y después de una serie de contracciones voluntarias máximas intermitentes (CVIM) (15 repeticiones - contracción 3 s, intervalo 3 s) utilizadas para causar fatiga muscular, monitoreadas por la frecuencia media (FMD) de la electromiografía VL, recto femoral y vasta medial. Antes y después del protocolo de fatiga, se obtuvieron imágenes de ultrasonido VL para medir el grosor muscular, la longitud del fascículo y el ángulo del fascículo. Se calculó el par isométrico máximo (PT-ISM) y las TDT en ventanas de 50 ms para cada CVIM. Las DTT se calcularon en valores absolutos y se normalizaron mediante PT-ISM. Resultados: la fatiga se confirmó por reducciones significativas en la fiebre aftosa de los tres músculos. Después de la fatiga, el PT-ISK se redujo de 239.0 ± 47.91 a 177.3 ± 34.96 Nm, y el PT-CVIM de 269.5 ± 45.63 a 220.49 ± 46.94 Nm. Todos los valores absolutos de TDT fueron significativamente diferentes después del protocolo de fatiga. Sin embargo, las TDT normalizadas no mostraron diferencias significativas. No se observaron diferencias significativas en la arquitectura muscular de la LV. Conclusiones: La reducción en la capacidad explosiva ocurrió simultáneamente con la reducción en la fuerza máxima, evidenciada por la falta de cambios en la TDT normalizada. Nível de evidencia III.

RESUMO Introdução: Alterações na taxa de desenvolvimento de torque (TDT) e arquitetura muscular causadas pela fadiga são temas pouco investigados. Esta pesquisa avaliou o efeito da fadiga na TDT e arquitetura muscular do vasto lateral (VL). Métodos: Dezessete voluntários (25,5 ± 6,2 anos; 177,2 ± 12,9 cm; 76,4 ± 13,1 kg) realizaram avaliação isocinética de extensão do joelho em 30º/s para obtenção do pico de torque (PT-ISK) antes e após uma série de contrações voluntárias isométricas máximas (CVIM) intermitentes (15 reps - 3 s contração, 3 s intervalo) utilizadas para causar fadiga muscular, monitoradas pela frequência mediana (FMD) da eletromiografia do VL, reto femoral e vasto medial. Antes e após o protocolo de fadiga, imagens de ultrassonografia do VL foram obtidas para mensuração da espessura muscular, comprimento de fascículo e ângulo do fascículo. O pico de torque isométrico (PT-ISM) e TDTs em janelas de 50 ms foram calculados para cada CVIM. As TDTs foram calculadas em valores absolutos e normalizadas pelo PT-ISM. Resultados: A fadiga foi confirmada devido a reduções significativas da FMD dos três músculos. Após a fadiga, o PT-ISK foi reduzido de 239,0 ± 47,91 para 177,3 ± 34,96 Nm, e o PT-CVIM de 269,5 ± 45,63 para 220,49 ± 46,94 Nm. Todos os valores de TDT absolutos apresentaram-se significativamente diferentes após o protocolo de fadiga. Contudo, as TDTs normalizadas não demonstraram diferença significativa. Não foram observadas diferenças significativas na arquitetura muscular do VL. Conclusões: A redução da capacidade explosiva ocorreu de maneira concomitante com a redução da força máxima evidenciada pela falta de alterações na TDT normalizada. Nível de Evidência III.

Reconstrucción del ligamento patelofemoral medial con autoinjerto de tendón cuadricipital / Reconstruction of the medial patellofemoral ligament with quadricipital tendon autograft

Resumen: Introducción: Las alteraciones de la articulación patelofemoral son una de las causas más comunes de dolor e inflamación así como de daño articular e inestabilidad de la rodilla. La inestabilidad patelofemoral es una entidad común multifactorial que requiere de una realineación mediante técnicas proximales, distales o una combinación de ellas. Entre los procedimientos proximales en tejidos blandos se encuentra la plastía del ligamento patelofemoral medial (LPFM), la cual tiene como objetivo realinear la patela hacia medial y restaurar la anatomía entre el tendón cuadricipital, patela y tubérculo de la tibia. Objetivo: Demostrar que la plastía del LPFM con autoinjerto de cuádriceps es una técnica efectiva y con bajo nivel de complicaciones. Material y métodos: Estudio observacional, longitudinal, retrospectivo, descriptivo, básico y clínico. Se presenta una serie de 15 pacientes operados con esta técnica entre Octubre de 2014 y Septiembre de 2019. Resultados: La plastía del LPFM con autoinjerto del cuadricipital es una técnica segura que no utiliza implantes, lo cual reduce el riesgo de complicaciones y restaura la anatomía del aparato extensor de la rodilla. Conclusión: Nuestra técnica con autoinjerto de cuádriceps es segura, con buenos resultados a mediano plazo y baja incidencia de complicaciones. Los pacientes han regresado a sus actividades deportivas previas sin episodios de reluxación.

Abstract: Introduction: Alterations of the patellofemoral joint are one of the most common causes of pain and inflammation as well as joint damage and instability of the knee. Patellofemoral instability is a common multifactorial entity, requiring realignment by proximal, distal, or a combination of techniques. Within the proximal procedures in soft tissues, is the medial patellofemoral ligament plasty (MPFL), which aims to realign the patella medially and restore the anatomy between the quadricipital tendon, patella and tubercle of the tibia. Objective: To demonstrate that the plasty of the LPFM with quadriceps autograft is an effective technique with a low level of complications. Material and methods: Observational, longitudinal, retrospective, descriptive, basic and clinical study. We present a series of 15 patients operated with this technique between October 2014 and September 2019. Results: LPFM plasty with autograft quadricipital is a safe technique, which does not use implants, which reduces the risk of complications and restores the anatomy of the extensor apparatus of the knee. Conclusion: Our technique of repair of the medial patellofemoral ligament, with quadriceps autograft is a safe, reproducible technique, with good results in the medium term, as well as a low incidence of complications. Patients have returned to their previous sports activities without episodes of re-dislocation.

Métodos de evaluación muscular para el diagnóstico de sarcopenia en pacientes cirróticos / Muscle assessment methods for the diagnosis of sarcopenia in cirrhotic patients

Resumen La sarcopenia es la pérdida de masa y función muscular. Su presencia ensombrece el pronóstico de los pacientes cirróticos. El gold standard para la descripción de sarcopenia es el Skeletal Muscle Index (SMI). Se incluyeron 34 pacientes cirróticos. Se realizó medición a través de tomografía computarizada de ambos psoas por separado, que luego fueron sumados obteniendo lo que se denominó "suma de área de 2 psoas", además se midió área muscular total, SMI y área total de psoas. También se realizó ecografía y se midió el área transversal de recto anterior del cuádriceps por ecografía y Hand Grip (HG). Se analizó la corre lación entre las distintas mediciones comparando con el área muscular total, con área de cuádriceps (r = 0.39; P = 0.019), con área total de psoas (r = 0.71; P < 0.01), con suma de área de 2 psoas (r= 0.72; P < 0.001) y con HG (r = 0.45; P = 0.0069). Comparado con el SMI, en mujeres el HG tuvo 86% sensibilidad y 66% especificidad (AUC = 0.89). En hombres la suma de 2 psoas tuvo 91.7% de sensibilidad y especificidad (AUC = 0.82) y el área total de psoas tuvo 83.3% de sensibilidad y 76.9% de especificidad (AUC = 0.8). Hubo muy buena correlación entre los métodos de tomografía con el gold standard, y la correlación con la ecografía y la fuerza fue buena. Evaluando sensibilidad, especificidad y AUC, no se consideró un método útil para ambos sexos, comparado con el SMI

Abstract Sarcopenia is the loss of muscle mass and function. Its presence darkens the prognosis of cirrhotic patients. The gold standard for the description of sarcopenia is the Skeletal Muscle Index (SMI). Thirty-four cirrhotic patients were included. Measurement was carried out through CT of both psoas separately that were then added obtain ing the so called "sum of area of 2 psoas", in addition total muscular area, SMI and total area of psoas were measured. Ultrasonography was also performed and the transverse area of the quadriceps rectus anterior was measured by ultrasound and Hand Grip (HG). The correlation between the different measurements was analyzed comparing with the total muscle area, with quadriceps area (r = 0.39; p = 0.019), with total psoas area (r = 0.71; p <0.01), with sum of area of 2 psoas (r = 0.72; p <0.001) and with HG (r = 0.45; p = 0.0069). Compared with SMI, in women HG had 86% sensitivity and 66% specificity (AUC = 0.89). In men, the sum of 2 psoas had 91.7% sensitivity and specificity (AUC = 0.82) and the total area of psoas had 83.3% sensitivity and 76.9% specificity (AUC = 0.8). There was a very good correlation between the tomography methods with the gold standard. The correlation with ultrasound and strength was good. In the evaluation of sensitivity, specificity and AUC, it was not found a useful method when comparing with the SMI.

Muscle oxygenation of the quadriceps and gastrocnemius during maximal aerobic effort / Oxigenación muscular de cuádriceps y gastrocnemio durante el esfuerzo aeróbico máximo / Oxigenação muscular de quadríceps e gastrocnêmio durante o esforço aeróbico máximo

ABSTRACT Introduction: Near infrared spectroscopy (NIRS) is a non-invasive technique that is used in the assessment of tissue oxygenation and the monitoring of physical activity. Objective: To determine the influence of sexual, anthropometric and ergospirometric factors on muscle oxygenation of the quadriceps and gastrocnemius, obtained by NIRS during a stress test. Methods: Twenty healthy subjects participated in this study (10 women). Two Humon Hex® devices were placed on the dominant side of the quadriceps and gastrocnemius muscles to measure muscle oxygen saturation (SmO2). The stress test was performed on a treadmill with electrocardiographic control and measurement of oxygen consumption. SmO2 was obtained at rest and after maximum effort during the stress test. In addition, the height, weight, skinfold and waist contour were measured. Bioimpedance was used to obtain the percentages of fat mass and muscle mass, which were used to calculate the relative fat mass (RFM). Results: The SmO2 of both muscles at rest is higher in males than in females. At maximum effort, the SmO2 of the quadriceps is similar in both groups. The SmO2 of both muscles is positively related to height, body mass, percentage of mass muscle and waist contour, and negatively with percentage of mass fat, RFM and skinfold thickness. The negative correlation between fat percentage and oxygen saturation is more evident in females. It was observed that the variables that quantify maximum effort are not related to the SmO2 values, except for the correlation between HR max and SmO2 of the gastrocnemius muscle in males. Conclusion: The SmO2 of recreational athletes is influenced by the location of the device and the fat mass of the subjects. The biggest differences between the sexes are in the gastrocnemius muscle. Level of Evidence II; Diagnostic Studies - Investigating a Diagnostic Test .

RESUMEN Introducción: La espectroscopia de infrarrojo cercano (NIRS) es una técnica no invasiva usada en la evaluación de la oxigenación tisular y en la monitorización de la actividad física. Objetivos: Determinar la influencia de factores sexuales, antropométricos y ergoespirométricos sobre la oxigenación muscular de cuádriceps y del gastrocnemio, obtenidos por NIRS durante un test de esfuerzo. Métodos: Participaron en este estudio 20 individuos saludables (10 mujeres). Se colocaron dos dispositivos Humon Hex® en el lado dominante de los músculos cuádriceps y gastrocnemio para medir la saturación de oxígeno muscular (SmO2). El test de esfuerzo fue realizado en una cinta ergométrica con control electrocardiográfico y medición del consumo de oxígeno. La SmO2 fue obtenida en reposo y después de esfuerzo máximo durante el test. Además, fueron medidos altura, peso, pliegues cutáneos y contorno de la cintura. Fue usada bioimpedancia para obtener los porcentuales de masa grasa y masa muscular, que fueron usados para calcular la masa grasa relativa (MGR). Resultados: La SmO2 de ambos músculos en reposo es mayor en hombres que en mujeres. En el esfuerzo máximo la SmO2 del cuádriceps es semejante en los dos grupos. La SmO2 de ambos músculos es positivamente relacionada con altura, masa corporal, porcentual de masa muscular y contorno de la cintura y negativamente relacionada con el porcentaje de masa grasa, MGR y espesor de los pliegues cutáneos. La correlación negativa entre el porcentual de grasa y la saturación de oxígeno es más evidente en las mujeres. Se observó que variables que cuantifican el esfuerzo máximo no está relacionadas con los valores SmO2, excepto por la correlación entre FCmáx y SmO2 del músculo gastrocnemio en sexo masculino. Conclusión: La SmO2 de los atletas recreativos es influenciada por la localización del dispositivo y por la masa grasa de los individuos. Las mayores diferencias entre los sexos están en el músculo gastrocnemio. Nivel de Evidencia II; Estudios diagnósticos - Investigación de un examen para diagnóstico .

RESUMO Introdução: A espectroscopia de infravermelho próximo (NIRS) é uma técnica não invasiva usada na avaliação da oxigenação tecidual e no monitoramento da atividade física. Objetivos: Determinar a influência de fatores sexuais, antropométricos e ergoespirométricos sobre a oxigenação muscular do quadríceps e do gastrocnêmio obtidos por NIRS durante um teste de esforço. Métodos: Participaram deste estudo 20 indivíduos saudáveis (10 mulheres). Dois dispositivos Humon Hex® foram colocados no lado dominante dos músculos quadríceps e gastrocnêmio para medir a saturação de oxigênio muscular (SmO2). O teste de esforço foi realizado em uma esteira com controle eletrocardiográfico e mensuração do consumo de oxigênio. A SmO2foi obtida em repouso e depois de esforço máximo durante o teste. Além disso, foram medidos estatura, peso, dobras cutâneas e contorno da cintura. A bioimpedância foi usada para obter os percentuais de massa gorda e massa muscular, que foram usados para calcular a massa gorda relativa (MGR). Resultados: A SmO2de ambos os músculos em repouso é maior em homens do que em mulheres. No esforço máximo, a SmO2do quadríceps é semelhante nos dois os grupos. A SmO2de ambos os músculos é positivamente relacionada com estatura, massa corporal, percentual de massa muscular e contorno da cintura e negativamente relacionada com a porcentagem de massa gorda, MGR e espessura das dobras cutâneas. A correlação negativa entre o percentual de gordura e a saturação de oxigênio é mais evidente nas mulheres. Observou-se que variáveis que quantificam o esforço máximo não estão relacionadas com os valores SmO2, exceto pela correlação entre FCmáx e SmO2do músculo gastrocnêmio no sexo masculino. Conclusão: A SmO2dos atletas recreativos é influenciada pela localização do dispositivo e pela massa gorda dos indivíduos. As maiores diferenças entre os sexos estão no músculo gastrocnêmio. Nível de Evidência II; Estudos diagnósticos - Investigação de um exame para diagnóstico .

Avulsão do tendão reto femoral em atleta amador: relato de caso diagnosticado pela ressonância magnética / Rectus femoris tendon avulsion in an amateur athlete: case report diagnosed by magnetic resonance

Introdução: o músculo reto femoral é o músculo mais frequentemente lesado do grupo quadríceps durante chutes e corridas repetitivas, apesar de suas avulsões serem raras. A dor localizada na coxa proximal e a incapacidade de flexionar o quadril e/ou estender o joelho associado à história do paciente de contração violenta ou alongamento forçado do grupo muscular do quadríceps femoral podem indicar uma avulsão do reto femoral. Objetivo: relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: revisão do prontuário, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: homem de 46 anos com dor localizada no quadril esquerdo com irradiação para a coxa por três meses após cair no chão com a região dolorida em um jogo de futebol. A dor começou subitamente uma semana após a queda. A ressonância magnética do quadril apresentava avulsão completa do reto femoral esquerdo, distando 2 cm da espinha ilíaca anterior inferior com efusão líquida adjacente. Conclusão: este relato demonstra a dificuldade de diagnosticar essa lesão, pois o seu exame físico é inespecífico, podendo simular patologias mais complexas, necessitando de exames complementares para seu correto diagnóstico.

Introduction: the rectus femoris muscle is the most frequently injured muscle of the quadriceps group during repetitive kicking and sprinting. Avulsions of the rectus femoris are rare injuries. Pain located at the proximal thigh and disability in flexing the hip and/or extending the knee associated with a patient history of a violent contraction or forceful stretching of the quadriceps femoris muscle group can indicate an avulsion of rectus femoris. Objective: report a case and review the literature about this uncommon lesion. Materials and Methods: we reviewed medical records, photographic records of diagnostic methods, and reviews from the literature. Results: a 46-year-old man with pain located at the left anterior hip with irradiation to the thigh for three months after falling to the ground with the sore region in a soccer game. The pain started suddenly one week after the fall. The MRI of the hip featured complete avulsion of the left rectus femoris, being 2 cm distal from the anterior inferior iliac spine with adjacent liquid effusion. Conclusion: this report demonstrates the difficulty of diagnosing this lesion, since its physical examination is non-specific, and it can simulate more complex pathologies, requiring complementary tests for its correct diagnosis.

Short-term Effect of Hip Muscles Strengthening on Knee Osteoarthritis / 中国康复理论与实践

Objective:To compare the short-term effects of hip muscles strengthening and quadriceps strengthening on knee osteoarthritis (KOA), and discuss the advantages of hip muscles strengthening. Methods:From October, 2015 to May, 2016, 42 old females with KOA were divided into two groups equally. They received hip strengthening (HS group) and quadriceps strengthening (QS group) for two weeks, respectively. The pain, stiffness and physical function scores of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured. Isokinetic strength peak torque (PT) was assessed for knee extensors and flexors, and 6-minute Walk Test was also evaluated. They were followed up two months later. Results:Before exercise, there was no significant difference in all the indexes between two groups (P > 0.05). Two weeks after exercise, the knee flexor PT (t = -4.038, P = 0.001) and 6-minute walk distance (t = -2.474, P = 0.022) increased in QS group; the pain, stiffness and physical function scores of WOMAC (t > 2.487, P < 0.05), the knee extensor and flexor PT (|t| > 6.370, P < 0.001), and 6-minute walk distance (t = -2.241, P = 0.037) improved in HS group; the scores of WOMAC were lower (t > 2.087, P < 0.05) and the knee extensor PT was higher (t = -5.028, P < 0.001) in HS group than in QS group. At two-months' follow-up, the drop-out rate was significantly lower in HS group than in QS group (χ2 = 13.480, P < 0.001). Conclusion:Hip muscles strengthening is a good choice for KOA in the early stage of treatment, which could avoid the pain in quadriceps training, increase quadriceps strength and improve physical function.

Different changes of muscle hardness between the rectus femoris and vastus intermedius muscle after maximal knee extension exercise / 体力科学

This study aimed to determine the different changes of muscle hardness between the human rectus femoris (RF) and vastus intermedius muscle (VI) after maximal knee extension exercise. Eight healthy men (23.0±2.6 years) performed maximal isometric contraction (IM), concentric contraction (CC), and eccentric contraction (EC) exercises of the knee extensors. Muscle hardness (i.e., strain ratio, SR) and thickness in the proximal, middle, and distal parts of RF and VI were measured by using strain elastography before and after exercises. The rates of change between the values were calculated as values before exercise 100%. For VI, a significant main effect in “part” was found in IM and EC exercises in SR. Results show that SR in the distal part (IM, 89.0±27.2%; EC, 78.2±26.9%) was significantly lower than that in the middle part (IM, 105.5±34.3%; EC, 91.8±30.4%) for each exercise (p<0.05). However, no significant main effect in “part” was found in SR of RF in any exercise. A significant main effect was found in “part” in muscle thickness of RF in the IM exercise. Also, muscle thickness in the distal part (104.5±7.7%) was significantly higher than that in the proximal part (102.5±4.3%) for each exercise (p<0.05). These results suggest that changes of muscle hardness and thickness in the proximal, middle, and distal parts of the human rectus femoris and vastus intermedius muscle after maximal knee extension exercises are different.

Measurement and evaluation of the quadriceps muscle mass in young men based on magnetic resonance imaging / 北京大学学报(医学版)

OBJECTIVE@#To investigate the correlation between the quadriceps cross-sectional area (CSA) and quadriceps muscle volume (QMV) at different horizontal levels from the upper edge of the patella, and to determine the best observation position.@*METHODS@#Thigh magnetic resonance imaging (MRI) images of 22 Chinese young men [age: (29±6) years] with anterior cruciate ligament (ACL) rupture were examined. The CSA was measured at 18, 15, and 12 cm above the upper edge of the pate-lla (denoted by CSA-18, CSA-15 and CSA-12 respectively), and the QMV and CSA were determined by semiautomatic segmentation. A curve model was established to estimate QMV. Bland-Altman analysis was performed to determine the confidence limits of the volumes.@*RESULTS@#On the unaffected side, the mean QMV was (1 944.45±323.77) cm3. The quadriceps CSA at the upper edge of the patella at 18, 15, and 12 cm was (80.80±12.16) cm2, (77.53±12.03) cm2, and (72.68±10.51) cm2, respectively. The coefficients of determination (R2), ascertained using curve estimation models, for the 3 positions were 0.819, 0.755, and 0.684 (P < 0.001), and the standard deviations of the volume estimated value (SEE) were 7.4%, 8.7%, and 9.8%. The fitting equations of the three horizontal positions were all good, but the fitting degree of CSA-18 was the highest. The Bland-Altman scatter plot showed that the arithmetic means of the QMV at 18, 15 and 12 cm from the upper edge of the patella 0.8 cm3, -1.1 cm3, and 0.9 cm3 and 95% limits of agreement (LoA) were (-268.8, 270.5), (-315.2, 313.1), and (-355.7, 357.5), respectively. The estimated QMV was in good agreement with the measured value. The difference between the estimated CSA-18 and measured values was the smallest. The results on the affected side were consistent.@*CONCLUSION@#The correlation between QMV and CSA in the young men with the upper edge of patella as baseline was reliable and consistent. Among them, CSA-18 had the highest correlation with the QMV. However, different observation sites could be selected for different injuries of the quadriceps.