Quanto de perda volumétrica e de força do músculo quadríceps femoral éesperada no pós-operatório da reconstrução do ligamento cruzado anterior?
Conteúdo do artigo principal
Resumo
Introdução: Observa-se, quando da lesão e/ou reconstrução do ligamento cruzado anterior, não somente que há diminuição da força, mas também da qualidade e da contração do quadríceps, além de atrofia muscular. A ressonância magnética e dinamometria isocinética têm oferecido melhor avaliação dos períodos pré e pós-cirúrgicos, podendo melhor monitorizar e prever a reabilitação pós-operatória.
Objetivos: Revisar o papel do volume e da força do músculo quadríceps femoral antes e após reconstrução do ligamento cruzado anterior e como estas medidas se correlacionam com as variáveis preditivas da força muscular pré e pós-operatória.
Método: Revisão integrativa colhendo informações em plataformas virtuais. Os textos foram selecionados do SciELO, Google Scholar, Pubmed e Scopus. Os descritores relacionados ao tema foram os seguintes: reconstrução do ligamento cruzado anterior; ressonância magnética; músculo quadríceps em português e inglês com busca AND ou OR, considerando o título e/ou resumo.
Resultados: Foi realizada a leitura da íntegra dos textos selecionados e incluídos 61 artigos.
Conclusão: Observou-se perda de volume e força do músculo quadríceps após a reconstrução. A perda da força muscular foi 4 vezes maior que a do volume pré- operatório e 2 vezes maior no pós-operatório com melhora após 4 meses da operação.
Detalhes do artigo

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Referências
Sherman DA, Rush J, Stock MS, Ingersoll CD, Norte GE. Neural drive and motor unit characteristics after anterior cruciate ligament reconstruction: implications for quadriceps weakness. Peer J. 2023;6(11):e16261. Doi: 10.7717/peerj.16261
Costa LA, Foni NO, Antonioli E, Carvalho RT, Paião ID, Lenza M, et al. Analysis of 500 anterior cruciate ligament reconstructions from a private institutional register. PlosOne. 2018;13(1):e0191414. Doi: 10.1371/journal.pone.0191414
Cone SG, Howe D, Fisher MB. Size and shape of the human anterior cruciate ligament and the impact of sex and skeletal growth: A systematic review. JBJS Reviews. 2019;7(6):e8. Doi: 10.2106/jbjs.rvw.18.00145
Øiestad BE, Juhl CB, Culvenor AG, Berg B, Thorlund JB. Knee extensor muscle weakness is a risk factor for the development of knee osteoarthritis: an updated systematic review and meta-analysis including 46 men and 819 women. Br J Sports Med. 2022;56(6);349-55. Doi: 10.1136/bjsports-2021-104861
Holmgrem D, Noory S, Mosntröm E, Grindem H, Stålman S, Wörner T. Weaker quadriceps muscle strength with a quadriceps tendon graft compared with a patellar or hamstring tendon graft at 7 months after anterior cruciate ligament reconstruction. Am J Sports Med. 2024;52(1):69-76. Doi: 10.1177/03635465231209442
Sherman DA, Baumeister J, Stock MS, Murray AM, Bazett-Jones DM, Norte GE. Weaker quadriceps corticomuscular coherence in individuals after reconstruction during force tracing. Med Sci Sports Exerc. 2023;55(4):625-32. Doi: 10.1249/mss.0000000000003080
Thomas AC, Wojtys EM, Brandon C, Palmieri-Smith RM. Muscle atrophy contributes to quadriceps weakness after anterior cruciate ligament reconstruction. J Sci Sports Med. 2016;19(1):7-11. Doi: 10.1016/j.jsams.2014.12.009
Williams GN, Buchanan TS, Barrance PJ, Axe MJ, Snyder-Mackler L. Quadriceps weakness, atrophy, and activation failure in predicted noncopers after anterior cruciate ligament injury. Am J Sports Med. 2005;33(3):402-7. Doi: 10.1177/0363546504268042
Tsai LC, Jeanfreau CM, Hamblin KA, Popovich JM, Lyle MA, Cottmeyer DF, et al. Time, graft, sex, geographic location, and isokinetic speed influence the degree of quadriceps weakness after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30(10):3367-76. Doi: 10.1007/s00167-022-06906-7
Johnson AK, Rodriguez KM, Lepley AS, Palmieri-Smith RM. Quadriceps torque complexity before and after anterior cruciate ligament reconstruction. J Sci Med Sport. 2023;26(10):533-8. Doi: 10.1016/j.jsams.2023.09.009
Rush JL, Glaviano NR, Norte GE. Assessment of quadriceps corticomotor and spinal-reflexive excitability in individuals with a history of anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Sports Med. 2021;51(5):961-90. Doi: 10.1007/s40279-020-01403-8
Pette D, Staron RS. Myosin isoforms, muscle fiber types, and transitions. Microsc Res Tech. 2000;50(6):500-9. Doi: 10.1002/1097-0029(20000915)50:6%3C500::aid-jemt7%3E3.0.co;2-7
Fleming JD, Ritzmann R, Centner C. Effect of an anterior cruciate ligament rupture on knee proprioception within 2 years after conservative and operative treatment: A systematic review with meta‑analysis. Sports Med. 2022;52(5):1091-102. Doi: 10.1007/s40279-021-01600-z
Schilaty ND, Mc Pherson AL, Nagai T, Bates NA. Arthogenic muscle inhibition manifest in thigh musculature motor unit characteristics after anterior cruciate ligament injury. Eur J Sport Sci. 2023;23(5):840-50. Doi: 10.1080/17461391.2022.2056520
Inns TB, Bass JJ, Hardy EJO, Wilkinson DJ, Stashuk DW, Atherton PJ, et al. Motor unit dysregulation following 15 days of unilateral lower limb immobilisation. J Physiol. 2022;600(21):4753-69. Doi: 10.1113/jp283425
Pietrosimone B, Lepley AS, Kuenze C, Harkey MS, Hart JM, Blackburn JT, et al. Arthrogenic muscle inhibition following anterior cruciate ligament injury. J Sport Rehabil. 2022;14(31):694-706. Doi: 10.1123/jsr.2021-0128
Baron JE, Parker EA, Duchman KR, Westermann RW. Perioperative and Postoperative factors influence quadriceps atrophy and strength after ACL reconstruction: a systematic review. Orthop J Sports Med. 2020;30(8):2325967120930296. Doi: 10.1177/2325967120930296
Garcia A, Curran MT, Palmieri-Smith RM. Longitudinal assessment of quadriceps muscle morphology before and after anterior cruciate ligament reconstruction and its associations with patient-reported outcomes. Sports Health. 2020;12(3):271-8. Doi: 10.1177/1941738119898210
Del Vechio A, Holobar A, Falla D, Felici F, Enoka RM, Farina D. Tutorial: Analisys of motor units discharge characteristics from high-density surface EMG signals. J Electromyogr Kinesiol. 2020;53:102426. Doi: 10.1016/j.jelekin.2020.102426
Sterczala AJ, Miller JD, Dimmick HL, Wray ME, Trevino MA, Herda TJ. Eight weeks of resistance training increases strength, muscle cross- sectional area and motor unit size, but does not alter firing rates in the vastus lateralis. Eur J Appl Physiol. 2020;120(1):281-94. Doi: 10.1007/s00421-019-04273-9
Curran MT, Bedi A, Kujawa M, Palmieri-Smith RA. A cross-sectional examination of quadriceps strength, biomechanical function, and functional performance from 9 to 24 months after anterior cruciate ligament reconstruction. Am J Sports Med. 2020;48(10):2438-446. Doi: 10.1177/0363546520940310
Pairot de Fontenay B, Willy RW, Elias ARC, Mizner RL, Dubé MO, Roy JS. Running biomechanics in individuals with anterior cruciate ligament reconstruction: A systematic review. Sports Med. 2019;49(9):1411-24. Doi: 10.1007/s40279-019-01120-x
Garcia SA, Moffit TJ, Vakula MN, Holmes C, Montgomery MM, Pamukoff DN. Quadriceps muscle size, quality, and strength and self-reported function in individuals with anterior cruciate ligament reconstruction. J Athlc Train. 2020;55(3):246-54. Doi: 10.4085/1062-6050-38-19
Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM. Quadriceps neuromuscular function in patients with anterior cruciate ligament reconstruction with or without knee osteoarthritis: across-sectional study. J Athl Train. 2018;53(5):475-85. Doi: 10.4085/1062-6050-102-17
Noehren B, Kosmac K, Walton G, Murach KA, Lyles MF, Loeser RF, et al. Alterations in quadriceps muscle cellular and molecular properties in adults with moderate knee osteoarthritis. Osteoarthritis Cartilage. 2018;26(10):4-35. Doi: 10.1016/j.joca.2018.05.011
Lie MM, Risberg MA, Storheim K, Engebretsen L, Øiestad BE. What’s the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review. Br J Sports Med. 2019;53(18):1162-7. Doi: 10.1136/bjsports-2018-099751
Patel AD, Bullock GS, Wrigley J, Paterno MV, Sell TC, Losciale JM. Does sex affect second ACL injury risk? A systematic review with meta-analysis. Br J Sports Med. 2021;55(15):873-82. Doi: 10.1136/bjsports-2020-103408
Sun Z, Cięszczyk P, Humińska-Lisowska K, Michałowska-Sawczyn M, Yue,S. Genetic determinants of the anterior cruciate ligament rupture in sport: an up-to-date systematic review. J Human Kinet. 2023;15(87):105-17. Doi: 10.5114%2Fjhk%2F163073
Montalvo AM, Schneider DK, Webster KE, Yut L, Galloway MT, Heidt RS, et al. Anterior cruciate ligament injury risk in sport: A Systematic review and meta-analysis of injury incidence by sex and sport classification. J Athl Train. 2019;54(5):472-82. Doi: 10.4085/1062-6050-407-16
Montalvo AM, Schneider DK, Yut L, Webster KE, Beynnon B, Kocher MS, et al. “What’s my risk of sustaining an ACL injury while playing sports?” A systematic review with meta-analysis. Br J Sports Med. 2019;53(16):1003-12. Doi: 10.4085/1062-6050-407-16
Hasani S, Feller JA, Webster KE. Familial Predisposition to anterior cruciate ligament injury: a systematic review with meta‑analysis. Sports Med. 2022;52(11):2657-68. Doi: 10.1007/s40279-022-01711-1
Bayer S, Meredith SJ, Wilson K, Sa D, Pauyo T, Byrne K, et al. Knee morphological risk factors for anterior cruciate ligament injury. J Bone Joint Surg. 2020;102(8):703-18. Doi: 10.2106/jbjs.19.00535
Brophy RH, Lowry KJ. American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary: Management of anterior cruciate ligament injuries. J Am Acad Orthop Surg. 2023;31(11):531-7. Doi: 10.5435/jaaos-d-22-01020
Birchmeier T, Lisee C, Kane K, Brazier B, Triplett A, Kuenze C. Quadriceps muscle size following ACL injury and reconstruction: A systematic review. J Orthop Res. 2020;38(3):598-608. Doi: 10.1002/jor.24489
Rodriguez K, Soni M, Joshi PK, Patel SC, Shreya D, Zamora DI, et al. Anterior cruciate ligament injury: Conservative versus surgical treatment. Cureus. 2021;13(12):e20206. Doi: 10.7759%2Fcureus.20206
Barford KW, Feller JA, Clark R, Hartwig T, Devitt BM, Webster, KE. Strength testing following anterior cruciate ligament reconstruction. A prospective cohort study 3 investigating overlap of tests. J Strength Cond Res. 2019;33(11):3145-50. Doi: 10.1519/jsc.0000000000002491
Niederer D, Kalo K, Vogel J, Wilke J, Giesche F, Vogt L, et al. Quadriceps torque, peak variability and strength endurance in patients after anterior cruciate ligament reconstruction: Impact of local muscle fatigue. J Motor Behav. 2020;52(1):22-32. Doi: 10.1080/00222895.2019.1570909
Moran U, Gottlieb U, Gam A, Springer S. Functional electrical stimulation following anterior cruciate ligament reconstruction: a randomized controlled pilot study. J Neuroeng Rehabil. 2019;16(1):89. Doi: 10.1186/s12984-019-0566-0
Huber R, Viecelli C, Bizzini M, Friesenbichler B, Dohm-Acker M, Rosenheck T, et al. Knee extensor and flexor strength before and after anterior cruciate ligament reconstruction in a large sample of patients: influence of graft type.Phys Sportsmed. 2019;47(1):85-90. Doi: 10.1080/00913847.2018.1526627
Hunnicutt JL, Gregory CM, Mcleod MM, Woolf SK, Chapin RW, Slone HS. Quadriceps recovery after anterior cruciate ligament reconstruction with quadriceps tendon versus patellar tendon autografts. Orthop J Sports Med. 2019;7(4):2325967119839786. Doi: 10.1177/2325967119839786
Johnston PT, Mcclelland JA, Feller JA, Webster KE. Knee muscle strength after quadriceps tendon autograft anterior cruciate ligament reconstruction: systematic review and meta‑analysis. Knee Surg Sports Traumatol Arthrosc. 2021;29(9):2918-33. Doi: 10.1007/s00167-020-06311-y
Wilson WT, Banger MS, Hopper GP, Blyth MJG, Mackay GM, Riches PE. Deficits in muscle strength are not seen following recovery from augmented primary repair of anterior cruciate ligament tears. J ISAKOS. 2023;8(6):436-41. Doi: 10.1016/j.jisako.2023.09.008
Hunnicutt JL, Mcleod MM, Slone HS, Gregory CM. Quadriceps muscle strength, size, and activation and physical function after anterior cruciate ligament reconstruction. J Athl Train. 2020;55(3):238-45. Doi: 10.4085%2F1062-6050-516-18
Zargi TG, Drobnic M, Koder J, Strazar K, Kacin A. The effects of preconditioning with ischemic exercise on quadriceps femoris muscle atrophy following anterior cruciate ligament reconstruction: a quasi- randomized controlled trial. Eur J Phys Rehabil Med. 2016;52(3):310–20.
Johnson AK, Rodriguez KM, Lepley AS, Palmieri-Smith RM. Quadriceps torque complexity before and after anterior cruciate ligament reconstruction. J Sci Sports Med. 2023;26(10):533-8. Doi: 10.1016/j.jsams.2023.09.009
Lepley AS, Gribble PA, Thomas AC, Tevald MA, Sohn DH, Pietrosimone BG. Quadriceps neural alterations in anterior cruciate ligament reconstructed patients: a 6-month longitudinal investigation. Scand J Med Sci Sports. 2015;25(6):828-39. Doi: 10.1111/sms.12435
Laboute E, Verhaeghe E, Ucay O, Minden A. Evaluation kinaesthetic proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in athletes. J Exp Orthop. 2019;6(1):6. Doi: 10.1186%2Fs40634-019-0174-8
Drigny J, Calmes A, Reboursière E, Hulet C, Gauthier A. Changes in the force-velocity relationship of knee muscles after anterior cruciate ligament reconstruction using the isokinetic 2-point model. Int J Sports Physiol Perform. 2023;18(11):1336-44. Doi: 10.1123/ijspp.2023-0108
Czamara A, Krzeminska K, Widuchowski W, Dragan SL. The muscle strength of the knee joint after ACL reconstruction depends on the number and frequency of supervised physiotherapy visits. Int J Environ Res Public Health. 2021;18(20):10588. Doi: 10.3390%2Fijerph182010588
Sherman DA, Glaviano NR, Norte GE. Hamstrings neuromuscular function after anterior cruciate ligament reconstruction: A Systematic review and meta‑analysis. Sports Med. 2021;51(8):1751-69. Doi: 10.1007/s40279-021-01433-w
Ebert JR, Edwards P, Annear, PT. Good clinical scores, no evidence of excessive anterior tibial translation, a high return to sport rate and a low re‑injury rate is observed following anterior cruciate ligament reconstruction using autologous hamstrings augmented with suture tape. Arch Orthop Trauma Surg. 2023;143(8):5207-20. Doi: 10.1007/s00402-023-04835-9
Norte GE, Knaus KR, Kuenze C, Handsfield GG, Meyer CH, Blemker SS, et al. MRI-based assessment of lower-extremity muscle volumes in patients before and after ACL reconstruction. J Sport Rehabil. 2018;27(3):201-12. Doi: 10.1123/jsr.2016-0141
D’ambrosi R, Ursino N, Feo F. Quadrupled semitendinosus anterior cruciate ligament reconstruction without the use of tourniquet and minimal instrumentation: The "double d" technique. Arthrosc Tech. 2023;12(9):e1589-93. Doi: 10.1016/j.eats.2023.05.008
Kochman M, Kasprzak M, Kielar A. ACL reconstruction: Which additional physiotherapy interventions improve early-stage rehabilitation? A systematic review. Int J Environ Res Public Health. 2022;19(3):15893. Doi: 10.3390/ijerph192315893
Carter HM, Littlewood C, Webster KE, Smith BE. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review. BMC Musculoskelet Disord. 2020;21(1):647. Doi: 10.1186/s12891-020-03676-6
Lisee C, Lepley AS, Birchmeier T, O’hagan K, Kuenze C. Quadriceps strength and volitional activation after anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Sports Health. 2019;11(2):163-79. Doi: 10.1177/1941738118822739
White AE, Nest DV, Tjoumakaris FP, Freedman KB. Journey around the notch: A systematic review on the history of ACL reconstruction in the United States. J Knee Surg. 2022;35(1):61-71. Doi: 10.1055/s-0040-1712947
Cronström A, Creaby MW, Ageberg E. Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies. BMC Musculoskel Disord. 2020;20(21):563. Doi: 10.1186/s12891-020-03552-3
Qiu J, He X, Fu S-C, Ong MT-Y, Leong HT, Yung PS-H. Is pre-operative quadriceps strength a predictive factor for the outcomes of anterior cruciate ligament reconstructions. Int J Sports Med. 2020;41(13):912-20. Doi: 10.1055/a-1144-3111
Kellis E, Sahinis C, Baltzopoulos V. Is hamstrings-to-quadriceps torque ratio useful for predicting anterior cruciate ligament and hamstring injuries? A systematic and critical review. J Sport Health Sci. 2023;12(3):343-58. Doi: 10.1016/j.jshs.2022.01.002
Carter HM, Lewis GN, Smith BE. Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review. BMC Musculoskelet Disord. 2023;24(1):471. Doi: 10.1186/s12891-023-06489-5
Crupzacki AP, Pereira CIP, Skare TL. Lesões musculoesqueléticas relacionadas ao trabalho em indivíduos em home office durante a pandemia COVID-19. BioSCIENCE.2022;80(2):28-31. Doi: 10.55684/80.2.6