A longitudinal study of muscle rehabilitation in the lower leg after cast removal using Magnetic Resonance Imaging and strength assessment

Maria Psatha, Zhi Qing Wu, Fiona M. Gammie, Aivaras Ratkevicius, Henning Wackerhage, Jennifer H Lee, Thomas W. Redpath, Fiona J. Gilbert, George P. Ashcroft, Judith R. Meakin, Richard M. Aspden

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Abstract

Magnetic resonance imaging (MRI) was used to investigate muscle rehabilitation following cast immobilization. The aim was to explore MRI as an imaging biomarker of muscle function. Sixteen patients completed an eight-week rehabilitation programme following six weeks of cast immobilization for an ankle fracture. MRI of the lower leg was performed at two-week intervals for 14 weeks. Total volume and anatomical cross-sectional areas at 70% of the distance from lateral malleolus to tibial tuberosity (ACSA) were measured for tibialis anterior (TA), medial and lateral gastrocnemius (GM and GL) and soleus (SOL). Pennation angle of muscle fascicules was measured at the same position in GM. Fractional fat/water contents and T2 relaxation times before and after exercise were calculated. Strength was measured as maximum isometric torque developed in plantar- and dorsi-flexion. Torque increased by (mean [SD]) 1.10 (0.32) N m day−1 in males, 0.74 (0.43) N m day−1 in females in plantar-flexion (0.9% of final strength per day), and 0.36 (0.15) N m day−1 in males, 0.28 (0.19) N m day−1 in females in dorsi-flexion (1.1% per day). Neither difference between males and females was significant. Volume and ACSA of muscles recovered by week 14 apart from SOL which was still 6.8% smaller (p = 0.006) than the contralateral leg. T2 peaked at the end of the cast period for TA and SOL, and at week 8 for GM before returning to baseline. Pennation angle recovered rapidly following cast removal. Quantitative MRI can generate markers of muscle biomechanics and indicates that many of these return to baseline within eight weeks of remobilization.
Original languageEnglish
Pages (from-to)101-112
Number of pages12
JournalInternational Biomechanics
Volume2
Issue number1
Early online date11 Aug 2015
DOIs
Publication statusPublished - 2015

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Patient rehabilitation
Longitudinal Studies
Muscle
Leg
Rehabilitation
Magnetic resonance imaging
Magnetic Resonance Imaging
Muscles
Torque
Immobilization
Ankle Fractures
Biomechanics
Biomarkers
Oils and fats
Biomechanical Phenomena
Relaxation time
Water content
Fats
Exercise
Imaging techniques

Keywords

  • muscles
  • magnetic resonance imaging
  • injury biomechanics
  • rehabilitation
  • biomarkers
  • exercise

Cite this

A longitudinal study of muscle rehabilitation in the lower leg after cast removal using Magnetic Resonance Imaging and strength assessment. / Psatha, Maria; Wu, Zhi Qing; Gammie, Fiona M.; Ratkevicius, Aivaras; Wackerhage, Henning; Lee, Jennifer H; Redpath, Thomas W.; Gilbert, Fiona J.; Ashcroft, George P.; Meakin, Judith R.; Aspden, Richard M.

In: International Biomechanics, Vol. 2, No. 1, 2015, p. 101-112.

Research output: Contribution to journalArticle

Psatha, Maria ; Wu, Zhi Qing ; Gammie, Fiona M. ; Ratkevicius, Aivaras ; Wackerhage, Henning ; Lee, Jennifer H ; Redpath, Thomas W. ; Gilbert, Fiona J. ; Ashcroft, George P. ; Meakin, Judith R. ; Aspden, Richard M. / A longitudinal study of muscle rehabilitation in the lower leg after cast removal using Magnetic Resonance Imaging and strength assessment. In: International Biomechanics. 2015 ; Vol. 2, No. 1. pp. 101-112.
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abstract = "Magnetic resonance imaging (MRI) was used to investigate muscle rehabilitation following cast immobilization. The aim was to explore MRI as an imaging biomarker of muscle function. Sixteen patients completed an eight-week rehabilitation programme following six weeks of cast immobilization for an ankle fracture. MRI of the lower leg was performed at two-week intervals for 14 weeks. Total volume and anatomical cross-sectional areas at 70{\%} of the distance from lateral malleolus to tibial tuberosity (ACSA) were measured for tibialis anterior (TA), medial and lateral gastrocnemius (GM and GL) and soleus (SOL). Pennation angle of muscle fascicules was measured at the same position in GM. Fractional fat/water contents and T2 relaxation times before and after exercise were calculated. Strength was measured as maximum isometric torque developed in plantar- and dorsi-flexion. Torque increased by (mean [SD]) 1.10 (0.32) N m day−1 in males, 0.74 (0.43) N m day−1 in females in plantar-flexion (0.9{\%} of final strength per day), and 0.36 (0.15) N m day−1 in males, 0.28 (0.19) N m day−1 in females in dorsi-flexion (1.1{\%} per day). Neither difference between males and females was significant. Volume and ACSA of muscles recovered by week 14 apart from SOL which was still 6.8{\%} smaller (p = 0.006) than the contralateral leg. T2 peaked at the end of the cast period for TA and SOL, and at week 8 for GM before returning to baseline. Pennation angle recovered rapidly following cast removal. Quantitative MRI can generate markers of muscle biomechanics and indicates that many of these return to baseline within eight weeks of remobilization.",
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AU - Psatha, Maria

AU - Wu, Zhi Qing

AU - Gammie, Fiona M.

AU - Ratkevicius, Aivaras

AU - Wackerhage, Henning

AU - Lee, Jennifer H

AU - Redpath, Thomas W.

AU - Gilbert, Fiona J.

AU - Ashcroft, George P.

AU - Meakin, Judith R.

AU - Aspden, Richard M.

N1 - Acknowledgements We thank the A&E nurses and plaster technicians for identifying suitable patients, the MRI radiographers for performing the scanning, Dr Scott Semple for invaluable help in some of the pilot studies and Mr E. C. Stevenson for constructing the footrest used in the scanner. We are very grateful to the dedicated patients themselves who gave considerable amounts of time to come in for scanning, exercise and assessment during the course of this study.

PY - 2015

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N2 - Magnetic resonance imaging (MRI) was used to investigate muscle rehabilitation following cast immobilization. The aim was to explore MRI as an imaging biomarker of muscle function. Sixteen patients completed an eight-week rehabilitation programme following six weeks of cast immobilization for an ankle fracture. MRI of the lower leg was performed at two-week intervals for 14 weeks. Total volume and anatomical cross-sectional areas at 70% of the distance from lateral malleolus to tibial tuberosity (ACSA) were measured for tibialis anterior (TA), medial and lateral gastrocnemius (GM and GL) and soleus (SOL). Pennation angle of muscle fascicules was measured at the same position in GM. Fractional fat/water contents and T2 relaxation times before and after exercise were calculated. Strength was measured as maximum isometric torque developed in plantar- and dorsi-flexion. Torque increased by (mean [SD]) 1.10 (0.32) N m day−1 in males, 0.74 (0.43) N m day−1 in females in plantar-flexion (0.9% of final strength per day), and 0.36 (0.15) N m day−1 in males, 0.28 (0.19) N m day−1 in females in dorsi-flexion (1.1% per day). Neither difference between males and females was significant. Volume and ACSA of muscles recovered by week 14 apart from SOL which was still 6.8% smaller (p = 0.006) than the contralateral leg. T2 peaked at the end of the cast period for TA and SOL, and at week 8 for GM before returning to baseline. Pennation angle recovered rapidly following cast removal. Quantitative MRI can generate markers of muscle biomechanics and indicates that many of these return to baseline within eight weeks of remobilization.

AB - Magnetic resonance imaging (MRI) was used to investigate muscle rehabilitation following cast immobilization. The aim was to explore MRI as an imaging biomarker of muscle function. Sixteen patients completed an eight-week rehabilitation programme following six weeks of cast immobilization for an ankle fracture. MRI of the lower leg was performed at two-week intervals for 14 weeks. Total volume and anatomical cross-sectional areas at 70% of the distance from lateral malleolus to tibial tuberosity (ACSA) were measured for tibialis anterior (TA), medial and lateral gastrocnemius (GM and GL) and soleus (SOL). Pennation angle of muscle fascicules was measured at the same position in GM. Fractional fat/water contents and T2 relaxation times before and after exercise were calculated. Strength was measured as maximum isometric torque developed in plantar- and dorsi-flexion. Torque increased by (mean [SD]) 1.10 (0.32) N m day−1 in males, 0.74 (0.43) N m day−1 in females in plantar-flexion (0.9% of final strength per day), and 0.36 (0.15) N m day−1 in males, 0.28 (0.19) N m day−1 in females in dorsi-flexion (1.1% per day). Neither difference between males and females was significant. Volume and ACSA of muscles recovered by week 14 apart from SOL which was still 6.8% smaller (p = 0.006) than the contralateral leg. T2 peaked at the end of the cast period for TA and SOL, and at week 8 for GM before returning to baseline. Pennation angle recovered rapidly following cast removal. Quantitative MRI can generate markers of muscle biomechanics and indicates that many of these return to baseline within eight weeks of remobilization.

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KW - injury biomechanics

KW - rehabilitation

KW - biomarkers

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