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Hamstrings Muscle Morphology After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

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Abstract

Background

Hamstrings muscle morphology is determinant of muscle function (i.e. strength). Among individuals with ACL reconstruction (ACLR), less cross-sectional area (CSA) and volume in the ACLR-limb are associated with muscle weakness, and may contribute to lower rates of return to preinjury activity level and an increased risk for long-term sequelae.

Objectives

To effectively treat muscular impairments, an accurate understanding of differences in hamstrings morphology following ACLR is needed. A systematic review and meta-analysis were undertaken to describe the morphology of the hamstring muscle complex after ACLR.

Methods

We searched five databases for studies evaluating the difference between hamstrings size and architecture in individuals with ACLR. Two independent reviewers assessed each paper for inclusion and quality. Means and standard deviations were extracted from each included study to allow fixed-effect size meta-analysis calculations for comparison of results.

Results

Twenty-four studies were included for final review. Eight categories of morphological outcomes were identified, and studies were grouped accordingly: (1) volume, (2) cross-sectional area (CSA), (3) muscle length, (4) muscle thickness, (5) fascicle length, (6) pennation angle, (7) fiber area, and (8) fiber type. Meta-analysis demonstrated lower hamstrings volume in the ACLR-limb in both contralateral and control group comparisons, and lower CSA, length, and thickness in the ACLR-limb in contralateral comparisons. The semitendinosus and gracilis were most profoundly impacted. Limited moderate evidence demonstrated greater biceps femoris pennation angle in the ACLR-limb.

Conclusions

Individuals with ACLR demonstrated large deficits in semitendinosus and gracilis muscle CSA and volume in the ACLR-limb compared contralaterally, with no differences observed in the biceps femoris or semimembranosus. Clinical implications regarding assessment and treatment of individuals with ACLR are discussed.

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Acknowledgements

The authors would like to acknowledge all participants that contributed to the original research reviewed in this work.

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Authors and Affiliations

  1. School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, 2801 W. Bancroft St.Mail Stop 119, Toledo, OH, HH 2505E, USA

    David A. Sherman, Justin L. Rush & Grant E. Norte

  2. Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT, USA

    Neal R. Glaviano

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  1. David A. Sherman
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Correspondence to David A. Sherman.

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Funding

No sources of funding were used to assist in the preparation of this article.

Conflicts of Interest

David Sherman, Justin Rush, Neal Glaviano and Grant Norte declare that they have no conflicts of interest relevant to the content of this review.

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PRISMA

Ethics approval

This is a systematic review. The University of Toledo Institutional Review Board for Biomedical Research has confirmed that no ethical approval is required.

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Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors' contributions

All authors (DAS, JLR, NRG, and GEN) have contributed equally and demonstrated significant involvement in the planning and carrying out of this review and manuscript. Material preparation and data extraction were performed by David Sherman. Methodological quality review was performed by David Sherman and Justin Rush. Data analysis was performed by David Sherman. The first draft of the manuscript was written by David Sherman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Sherman, D.A., Rush, J.L., Glaviano, N.R. et al. Hamstrings Muscle Morphology After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Sports Med 51, 1733–1750 (2021). https://doi.org/10.1007/s40279-021-01431-y

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