Quantifying Muscle Volume Deficits Among 38 Lower Extremity Muscles in Collegiate Football Athletes After Anterior Cruciate Ligament Reconstruction

Naoaki Ito^{1

2

3}, Jack A Martin^{1

2

4

3}, Mikel R Joachim^{1

2

3}, Silvia S Blemker^{5

6

3}, David A Opar^{7

8

3}, Stephanie A Kliethermes^{1

2

3}, Bryan C Heiderscheit^{1

2

3}; HAMIR Consortium Investigators³; Geoffrey Baer^{9

10

3}, Kurrel Fabian^{10

3}, Erin Hammer^{9

10

3}, Danielle Heidt^{10

3}, Matthew Kuehl^{10

3}, Kenneth Lee^{11

3}, Michael Moll^{10

3}, Ryan Peot^{10

3}, Jennifer Sanfilippo^{10

3}, Claire Tanaka^{9

10

3}, Sarah Sund^{9

3}, Yi-Chung Lin^{12

13

3}, Jack Hickey^{12

13

3}, Ashleigh Homer^{12

13

3}, Nirav Maniar^{12

13

3}, Ryan Timmins^{12

13

3}, Matthew Cousins^{14

3}, Olivia DuCharme^{14

3}, Xue Feng^{14

3}, Anthony Nguyen^{14

3}, Lara Riem^{14

3}, Joseph Hart^{15

3}, Noah McCoy^{15

3}, Dain Allred^{16

3}, Anthony Beutler^{16

3}, Darren Campbell^{16

3}, A Wayne Johnson^{16

3}, Malorie Wilwand^{16

3}, Brett Mortensen^{16

3}, Emma Remington^{16

3}, Jonathon Hauenstein^{17

3}, Casey Metoyer^{17

3}, John Wagle^{17

3}, Josh Huff^{18

3}, Nicholas Port^{18

3}, Jordan Reyes^{18

3}

Affiliations

¹ Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.
² Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin, USA.
³ Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA.
⁴ Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.
⁵ Springbok Analytics, Charlottesville, Virginia, USA.
⁶ Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.
⁷ Sports Performance, Recovery, Injury and New Technologies Research Centre, Australian Catholic University, Melbourne, Victoria, Australia.
⁸ School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia.
⁹ Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
¹⁰ Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA.
¹¹ Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
¹² Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, Australia.
¹³ School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, Australia.
¹⁴ Springbok Analytics, USA.
¹⁵ University of North Carolina, Chapel Hill, NC, USA.
¹⁶ Brigham Young University, Provo, UT, USA.
¹⁷ University of Notre Dame, South Bend, IN, USA.
¹⁸ Indiana University, Bloomington, IN, USA.

PMID: 39876616
DOI: 10.1177/03635465241313235

Multicenter Study

Quantifying Muscle Volume Deficits Among 38 Lower Extremity Muscles in Collegiate Football Athletes After Anterior Cruciate Ligament Reconstruction

Naoaki Ito et al. Am J Sports Med. 2025 Mar.

. 2025 Mar;53(4):809-816.

doi: 10.1177/03635465241313235. Epub 2025 Jan 28.

Authors

Affiliations

¹ Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.
² Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin, USA.
³ Investigation performed at the University of Wisconsin-Madison, Madison, Wisconsin, USA.
⁴ Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.
⁵ Springbok Analytics, Charlottesville, Virginia, USA.
⁶ Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.
⁷ Sports Performance, Recovery, Injury and New Technologies Research Centre, Australian Catholic University, Melbourne, Victoria, Australia.
⁸ School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia.
⁹ Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
¹⁰ Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA.
¹¹ Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
¹² Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, Australia.
¹³ School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, Australia.
¹⁴ Springbok Analytics, USA.
¹⁵ University of North Carolina, Chapel Hill, NC, USA.
¹⁶ Brigham Young University, Provo, UT, USA.
¹⁷ University of Notre Dame, South Bend, IN, USA.
¹⁸ Indiana University, Bloomington, IN, USA.

PMID: 39876616
DOI: 10.1177/03635465241313235

Abstract

Background: Quadriceps dysfunction is ubiquitous after anterior cruciate ligament (ACL) reconstruction (ACLR). Addressing quadriceps dysfunction is crucial to improve function, reduce the reinjury risk, and maintain long-term knee health. While deficits specific to the quadriceps are well documented, less is known about the effect of an ACL injury on other lower extremity muscle groups.

Purpose/hypothesis: The purpose of this exploratory analysis was to quantify and rank lower extremity muscle volume deficits using magnetic resonance imaging in collegiate football athletes after ACLR. It was hypothesized that the quadriceps muscles would present with the greatest deficits and that compensatory hypertrophy of muscles at adjacent joints such as the hip and ankle would be observed.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: This study is a secondary analysis from an ongoing multicenter prospective cohort study involving Division I collegiate football athletes. Athletes who underwent primary unilateral ACLR (1 [3%] allograft, 2 [7%] quadriceps tendon autograft, 22 [73%] bone-patellar tendon-bone autograft, 5 [17%] hamstring tendon autograft) and magnetic resonance imaging were included. Muscle volumes (mL·kg^-1·m^-1) were quantified bilaterally from 38 lower extremity muscles using machine learning technology. Paired-samples t tests were performed between limbs for each muscle, which were then ranked and visualized in a forest plot based on standardized mean differences (surgical - nonsurgical limb).

Results: A total of 30 athletes (mean time from surgery, 27.9 ± 19.0 months) were included. The largest muscle volume deficits in the surgical limb were seen in the 3 uniarticular quadriceps muscles, followed by the biarticular triceps surae muscles. The rectus femoris and soleus did not show significant differences between limbs. Conversely, the fibularis muscle group had a greater muscle volume in the surgical limb compared with the nonsurgical limb. Most other muscle groups did not present significant differences between limbs.

Conclusion: Persistent quadriceps atrophy in a cohort of high-level athletes over 2 years after ACLR was highlighted in this study. Deficits in the gastrocnemius muscles, but not in the soleus, were also identified. This comprehensive approach examining various lower extremity muscles revealed latent muscle volume deficits present after ACLR.

Keywords: atrophy; gastrocnemius; machine learning; magnetic resonance imaging; quadriceps.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by research funding from the National Football League (NFL). The NFL had no role in the study design, collection, analysis, or interpretation of the data presented and was not involved in the writing of the manuscript or in the decision to submit the manuscript for publication. S.S.B. (cofounder and Chief Science Officer) and B.C.H. (advisory board member) declare potential competing interests related to this work because of their roles with Springbok Analytics. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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Quantifying Muscle Volume Deficits Among 38 Lower Extremity Muscles in Collegiate Football Athletes After Anterior Cruciate Ligament Reconstruction

Affiliations

Quantifying Muscle Volume Deficits Among 38 Lower Extremity Muscles in Collegiate Football Athletes After Anterior Cruciate Ligament Reconstruction

Authors

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

Full Text Sources

Medical