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Lower Limb Muscle Size after Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis

  • Systematic Review
  • Published:
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A Letter to the Editor to this article was published on 21 October 2021

A Letter to the Editor to this article was published on 21 October 2021

Abstract

Background

Anterior cruciate ligament (ACL) injury is known to have a number of deleterious effects on lower limb muscle function. Alterations in muscle size are one such effect that have implications towards reductions in strength and functioning of the lower limbs. However, a comprehensive analysis of alterations in muscle size has yet to be undertaken.

Objective

To systematically review the evidence investigating lower limb muscle size in ACL injured limbs.

Design

Systematic review

Data Sources

Database searches of Medline, SPORTDiscus, Embase, Cinahl and Web of Science as well as citation tracking and manual reference list searching.

Eligibility Criteria for Selecting Studies

Individuals with ACL deficient or reconstructed limbs with an assessment of lower limb muscle size and control limb data (contralateral or uninjured control group)

Methods

Risk of bias assessment was completed on included studies. Data were extracted and where possible meta-analyses performed. Best evidence synthesis was also undertaken.

Results

49 articles were included in this review, with 37 articles included in the meta-analyses. 66 separate meta-analyses were performed using various measures of lower limb muscle size. Across all measures, ACL deficient limbs showed lesser quadriceps femoris muscle size (d range = − 0.35 to − 0.40), whereas ACL reconstructed limbs showed lesser muscle size in the quadriceps femoris (d range = − 0.41 to − 0.69), vastus medialis (d = − 0.25), vastus lateralis (d = − 0.31), hamstrings (d = − 0.28), semitendinosus (d range = − 1.02 to − 1.14) and gracilis (d range = − 0.78 to − 0.99) when compared to uninjured limbs.

Conclusion

This review highlights the effect ACL injury has on lower limb muscle size. Regardless of whether an individual chooses a conservative or surgical approach, the quadriceps of the injured limb appear to have lesser muscle size compared to an uninjured limb. When undertaking reconstructive surgery with a semitendinosus/gracilis tendon graft, the harvested muscle shows lesser muscle size compared to the uninjured limb.

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Acknowledgements

We would like to thank Jessica Dickson, Senior Librarian at Australian Catholic University, Melbourne, Australia, for help preparing the literature search strategy.

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Authors and Affiliations

  1. School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia

    Benjamin Dutaillis, Nirav Maniar, David A. Opar, Jack T. Hickey & Ryan G. Timmins

  2. Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC, 3065, Australia

    David A. Opar & Ryan G. Timmins

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  1. Benjamin Dutaillis
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  2. Nirav Maniar
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  3. David A. Opar
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Correspondence to Benjamin Dutaillis.

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Conflict of interest

Benjamin Dutaillis, Nirav Maniar, David Opar, Jack Hickey and Ryan Timmins declare that they have no conflicts of interest relevant to the content of this review.

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Author contributions

Concept and design (BD, NM, DAO and RGT), running of search strategy (BD), inclusion/exclusion criteria assessment (BD and JTH), quality assessment (BD and RGT), data extraction (BD), data analysis and interpretation (BD, NM, DAO, JTH and RGT), manuscript preparation (BD, NM, DAO, JTH and RGT).

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Dutaillis, B., Maniar, N., Opar, D.A. et al. Lower Limb Muscle Size after Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis. Sports Med 51, 1209–1226 (2021). https://doi.org/10.1007/s40279-020-01419-0

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  • DOI: https://doi.org/10.1007/s40279-020-01419-0

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