Use of vastus lateralis muscle flap for repair of trochanteric pressure sores.

The use of a vastus lateralis muscle flap is suggested as an approach to the surgical repair of trochanteric pressure sores in paraplegic patients. The details of the anatomy of the muscle are outlined, and our surgical technique for its use is described.     

Distally based vastus lateralis muscle flap for coverage of wounds about the knee

The blood supply to the vastus lateralis muscle has been evaluated by dye injection techniques in fresh cadaver dissections. The main dominant blood supply is the descending branch of the lateral femoral circumflex artery. Vascular contributions from distal perforators of the superficial femoral artery, the superior geniculate artery, fill the main vascular pedicle in a retrograde fashion. Latex staining is observed consistently in the proximal third of the muscle. Five patients are presented in whom the distally based vastus lateralis muscle flap was successfully used to cover defects above the knee. Superficial muscle necrosis is a complication of this operation but has not precluded its usefulness. It is anticipated that this flap will be useful in the armamentarium of reconstructive surgeons treating such problematic patients.     

Assessment of quadriceps muscle weakness in patients after total knee arthroplasty and total hip arthroplasty: Methodological issues

The aim of this exploratory study was to verify whether the evaluation of quadriceps muscle weakness is influenced by the testing modality (isometric vs. isokinetic vs. isoinertial) and by the calculation method (within-subject vs. between-subject comparisons) in patients 4–8 months after total knee arthroplasty (TKA, n = 29) and total hip arthroplasty (THA, n = 30), and in healthy controls (n = 19). Maximal quadriceps strength was evaluated as (1) the maximal voluntary contraction (MVC) torque during an isometric contraction, (2) the peak torque during an isokinetic contraction, and (3) the one repetition maximum (1-RM) load during an isoinertial contraction. Muscle weakness was calculated as the difference between the involved and the uninvolved side (within-subject comparison) and as the difference between the involved side of patients and controls (between-subject comparison). Muscle weakness estimates were not significantly affected by the calculation method (within-subject vs. between-subject; P > 0.05), whereas a significant main effect of testing modality (P < 0.05) was observed. Isometric MVC torque provided smaller weakness estimates than isokinetic peak torque (P = 0.06) and isoinertial 1-RM load (P = 0.008), and the clinical occurrence of weakness (proportion of patients with large strength deficits) was also lower for MVC torque. These results have important implications for the evaluation of quadriceps muscle weakness in TKA and THA patients 4–8 months after surgery.     

Increased total concentration of Na-K pumps in vastus lateralis muscle of old trained human subjects

The concentration of Na-K pumps was measured as the total capacity for [3H]ouabain binding in needle biopsies of the vastus lateralis muscle. Samples were obtained from young (28 +/- 0.2 yr) and old (68 +/- 0.6 yr) untrained control subjects and from groups of age-matched old trained subjects, who had been performing well-defined training programs at regular intervals for 12-17 yr. Measurements of maximum isometric force in knee extension showed that running and, especially, strength training produced a significant increase, whereas swim training was without effect. Both running and swim training increased endurance of knee extension, whereas strength training had a negative effect. When compared with untrained age-matched subjects, the swim-, running-, and strength-trained subjects demonstrated increased concentration of [3H]ouabain binding sites of 30% (P less than 0.01), 32% (P less than 0.05), and 40% (P less than 0.05), respectively. In the entire group of 28 individuals tested, maximum isometric strength and the concentration of [3H]ouabain binding sites showed correlation (r = 0.49, P less than 0.01). This upregulation of Na-K pump concentration might contribute to the reduction in exercise-induced hyperkalemia seen in trained subjects.     

Validity of fascicle length estimation in the vastus lateralis and vastus intermedius using ultrasonography

The purpose of this study was to determine the validity of fascicle length estimation in the vastus lateralis (VL) and vastus intermedius (VI) using ultrasonography. The fascicle lengths of the VL and VI muscles were measured directly (dFL) using calipers, and were estimated (estmFL) using ultrasonography, in 10 legs from five Thiel’s embalmed cadavers. To determine the validity of the estmFLs, FL was estimated using five previously published models and compared with dFL. The intraclass correlation coefficients (ICCs) of two of the five models were > 0.75, indicating that these estimates were valid. Both of these models combined measurement of the length of the visible part of the fascicle with linear extrapolation of the length of the part of the fascicle that was not visible on the sonographic image. The ICCs and absolute% difference were best in models that used appropriate pennation angles. These results suggest that two of the five previously published models are valid for obtaining estmFL of the VL and VI using ultrasonography.     

Relationship between EMG signals and force in human vastus lateralis muscle using multiple bipolar wire electrodes.

This paper describes the relationship between knee extension force and EMG signals detected by multiple bipolar wire electrodes inserted into the human vastus lateralis muscle under isometric conditions. Six healthy male volunteers participated in this study. Eight pairs of bipolar wire electrodes were inserted into the right vastus lateralis muscle and the EMG data were simultaneously detected and analyzed. The EMG raw data and individual force-IEMG relations were influenced by the location of the electrode inserted into the muscle. The force and IEMG relationship averaged across subjects detected from the eight electrodes, however, showed almost the same linear correlation in spite of different electrode locations. No linear correlation was observed between MdF and the knee extension force. This result suggests that, if all of the muscle fibers participate in the same action at the same time, the averaged normalized IEMG from any places using wire electrodes could reflect the total activities of that muscle even if the muscle is large.     

Pelvic instability and trunk and hip muscle recruitment patterns in patients with total hip arthroplasty

Hip and lumbar spine disorders often coexist in patients with total hip arthroplasty (THA). The current study aimed to reveal pelvic motion pathology and altered trunk and hip muscle recruitment patterns relating to pelvic motion in patients with THA. Twenty-one women who underwent THA and 12 age-matched healthy women were recruited. Pelvic kinematics and muscle recruitment patterns (i.e., amplitude, activity balance, and onset timing) of the gluteus maximus, semitendinosus, multifidus, and erector spinae were collected during prone hip extension. Compared with healthy subjects, the patients showed increased pelvic motion, especially ventral rotation, decreased multifidus muscle activity relative to the hip extensors, and delayed onset of multifidus activity, despite reaction times and speeds of leg motion not being significantly different between the groups. Furthermore, while contributing factors associated with ventral pelvic rotation were not found, delayed onset of multifidus activity was detected as a factor related to the increased anterior tilt of the pelvis (r = 0.47, p < 0.05) in patients with THA. These results suggest that patients with THA have dysfunction of the stabilizer muscles of the lumbopelvic region along with increased pelvic motion.     

Quantitative analysis of changes occurring in muscle vastus lateralis in patients with heart failure after low-intensity training

OBJECTIVE: To quantitate the changes occurring in muscle vastus lateralis after exercise training of low intensity adopted for the rehabilitation of patients with chronic heart failure. STUDY DESIGN: Nine consecutive males with a clinical diagnosis of idiopathic dilated and ischemic cardiomyopathy underwent an eight-week period of training. The intensity of the work was calculated as 40% of peak VO2. The program consisted of 30 minutes of cycling three times per week. A cardiopulmonary exercise test, hemodynamic measurements and echocardiographic studies were carried out. Needle biopsies were taken from muscle vastus lateralis before starting and after completing training. Quantitative analysis was carried out on sections stained with ATPase at pH 9.5 for measurement of the lesser diameter of type 1 and 2 fibers (by using an image analyzer) and on UEA 1-stained sections for capillary density and capillary/fiber ratio (by using a frame in the eyepiece of the microscope). The Wilcoxon test was applied to identify significant differences before and after training. Spearman's rank correlation coefficient was also calculated to highlight any correlation between the morphologic data and results of clinical tests. RESULTS: After completing the training program, all the patients experienced an improvement in exercise tolerance and a significant increase (P < .004) in the VO2 and VCO2 peak. Skeletal muscle showed a significant (P < .02) increase in the capillary/fiber ratio. The changes were not significantly correlated with any of the clinical findings. CONCLUSION: Low-intensity training can improve the functional capacity of patients with heart failure while producing only mild morphologic changes in their muscles.     

Capillary density and capillary-to-fibre ratio in vastus lateralis muscle of untrained and trained men

Muscle fibre profile area (Af), volume density (Vv), capillary-to-fibre ratio (CF) and number of capillaries per fibre square millimetre (CD) were determined from needle biopsies of vastus lateralis of twenty-four male volunteers (mean +/- SD: age 25.4+/-5.8 years, height 178.6+/-5.5 cm, body mass 72.1+/-7.7 kg) of different training background. Seven subjects were untrained students (group A), nine were national and sub-national level endurance athletes (group B) with the background of 7.8+/-2.9 years of specialised training, and eight subjects were sprint-power athletes (group C) with 12.8+/-8.7 years of specialised training. Muscle biopsies of vastus lateralis were analysed histochemically for mATPase. Capillaries were visualized and counted using CD31 antibodies against endothelial cells. There were significant differences in the Vv of type I and type II muscle fibres in both trained groups, B (51.8%; 25.6%) and C (50.5%; 26.4%). However, in untrained group A that was treated as a reference group, the difference between Vv of type I and type II fibres was less prominent, nevertheless statistically significant (42.1%; 35.1%). There was also a significant difference in CF: 1.9 in group A and 2.1 in groups B and C. The number of capillaries per mm2 (CD) was 245 (group A), 308 (group B) and 325 (group C). Significant differences (P<0.05) in CF and CD, were found only between group A (1.9; 245) and both groups of trained men, B and C (2.1; 308 and 325). However, endurance athletes (group B), such as long-distance runners, cyclists and cross country skiers, did not differ from the athletes representing short term, high power output sports (group C) such as ice hockey, karate, ski-jumping, volleyball, soccer and modern dance.     

Assessment of hip extensor and flexor strength two months after unilateral total hip arthroplasty

This investigation assessed strength of the hip extensors and flexors when assistive devices and weight bearing are changing after total hip arthroplasty (THA). Eleven individuals (6 men, 5 women; mean age 74.45 +/- 4.88 years) with unilateral THA were evaluated isokinetically at 60 degrees x sec(-1) before surgery on the involved and uninvolved limbs. Each subject's involved limb was tested 60 days after surgery. Comparisons were made between involved and uninvolved limbs and between the involved limb before surgery and 60 days after surgery for both the hip extensors and flexors. Hip extensor and flexor strength before surgery on the involved side was 39% and 29% lower, respectively, compared with the uninvolved side. Sixty days after surgery, strength of the hip extensors and flexors improved 50% and 27%, respectively, compared with before surgery. Over the 60-day interval, the responsiveness of isokinetic testing was high for both muscle groups (range, 0.74-1.51). It would seem appropriate that intensive rehabilitation continue through at least the 60-day period and that isokinetic testing is an effective tool to monitor hip strength before and after surgery.     

Fiber type composition of the vastus lateralis muscle of young men and women.

This study presents data collected over the past 10 years on the muscle fiber type composition of the vastus lateralis muscle of young men and women. Biopsies were taken from the vastus lateralis muscle of 55 women (21.2+/-2.2 yr) and 95 men (21.5+/-2.4 yr) who had volunteered to participate in various research projects. Six fiber types (I, IC, IIC, IIA, IIAB, and IIB) were classified using mATPase histochemistry, and cross-sectional area was measured for the major fiber types (I, IIA, and IIB). Myosin heavy chain (MHC) content was determined electrophoretically on all of the samples from the men and on 26 samples from the women. With the exception of fiber Type IC, no significant differences were found between men and women for muscle fiber type distribution. The vastus lateralis muscle of both the men and women contained approximately 41% I, 1% IC, 1% IIC, 31% IIA, 6% IIAB, and 20% IIB. However, the cross-sectional area of all three major fiber types was larger for the men compared to the women. In addition, the Type IIA fibers were the largest for the men, whereas the Type I fibers tended to be the largest for the women. Therefore, gender differences were found with regard to the area occupied by each specific fiber type: IIA>I>IIB for the men and I>IIA>IIB for the women. These data establish normative values for the mATPase-based fiber type distribution and sizes in untrained young men and women.     

Four-dimensional model of the lower extremity after total hip arthroplasty

We have developed a four-dimensional (4D) model of the lower extremities after total hip arthroplasty in patients. The model can aid in preventing complications such as dislocation and wearing of the sliding surface. The skeletal structure and implant alignment were obtained from CT data. We applied registration method using CAD data to estimate accurate implant alignment from scattered CT data. The reconstructed three-dimensional (3D) skeletal model was combined with motion capture data that were acquired by an optical tracking system. We displayed the patient's skeletal movement and analyzed several parameters that relate to complications. The patient's skeletal model was superimposed onto video footage that was taken by a synchronized and calibrated digital video camera. For validation of the measurement error in this system, we used open MRI to evaluate the relative movement between skin markers and bones. This system visually represents not only the 3D anatomical structure, but also 4D dynamic functions that include the time sequential transitions of components and their positions. The open MRI results indicated that the average error in hip angle was within 5° for each static posture. This system enables clinicians to analyze patient's motions on the basis of individual differences. We found that our system was an effective tool in providing precise guidance of daily postoperative motions that was individualized for each patient. This system will be applicable for surgical planning, assessment of postoperative activities, and the development of new surgical techniques, materials, and prosthetic designs.     

Comparison of the muscle activation pattern for the vastus lateralis before and after an 8-week resistance training program

The purpose of this investigation was to use wavelet analyses and pattern classification techniques to examine potential changes in the joint time–frequency distribution of surface electromyographic (EMG) signals due to an 8-week resistance training program. Thirteen untrained men (mean ± S.D. age = 22.2 ± 4.0 yrs) performed eight separate submaximal isometric muscle actions of the dominant leg extensors in 10% increments from 10 to 80% of the maximum voluntary contraction (MVC). During each muscle action, a monopolar surface EMG signal was detected from the vastus lateralis. All signals were then analyzed with a wavelet analysis designed specifically for EMG signals, and the resulting intensity patterns were classified using pattern classification techniques into their respective pre-training versus post-training categories. The results showed accuracy rates (% of correctly classified patterns) that ranged from approximately 62 to 92%, but these rates did not change consistently with increases in force. In addition, for five of the eight submaximal force levels, the classification was considered to be significantly different from random. Thus, although the differences between the pre- and post-training EMG intensity patterns were not always consistent, our findings did suggest that there is the potential for wavelet analyses and pattern classification techniques to be used to examine neuromuscular adaptations during resistance training.     

Retransfusion of unwashed drainage blood after total hip and knee arthroplasty]

The method of retransfusion of drainage blood as known from the literature was investigated in a prospectiv study regarding effectivness and rate of side effects. 200 patients who underwent total hip and knee arthroplasty were investigated concerning hemoglobin, hematocrit, amount and quality of the retransfused drainage blood, the amount of autologous and homologous transfusions as well as complications and costs. 100 of these patients were selected as the control group. The amount of the retransfused drainage blood after hip arthroplasty amounted an average of 387 +/- 194 ml and after knee arthroplasty 595 +/- 250 ml. The retransfused blood had an average hemoglobin of 5,2 +/- 0,9mmol/l with a hematocrit of 0,24 0,05. No complications directly associated to the retransfusion were found. The need of transfusion was reduced for patients with knee arthroplasty about 30% and for hip arthroplasty about 25%. The retransfusion of unwashed drainage blood is a sufficient method to reduce perioperative homologous blood transfusion in patients with arthroplasty of hip and knee. Substantial complications were not observed, so that this method seems to be save enough for clinical usage. The method is easy to handle and usable without special technical devices. The autologous retransfusion of drainage blood can contribute to lower costs in patients treatement.     

Effect of obesity on inpatient rehabilitation outcomes after total hip arthroplasty

Objective: This study examined whether obesity affected inpatient rehabilitation outcomes after total hip arthroplasty (THA). Research Methods and Procedures: This was a retrospective, comparative study conducted using a computerized medical database derived from THA patients at a university‐affiliated rehabilitation hospital (data from 2002 to 2005). Patients were divided into four brackets based on BMI: non‐obese (<25 kg/m²), overweight (25 to 29.9 kg/m²), moderate obesity (30 to 39.9 kg/m²), and severe obesity (≥40 kg/m²). All patients completed an interdisciplinary inpatient rehabilitation program after THA. Functional independence measure (FIM) scores, length of stay (LOS), FIM efficiency scores (FIM/LOS), hospital charges, and discharge disposition location were collected. Results: FIM scores improved from admission to discharge similarly in all groups (25 to 29.5 points). However, FIM efficiency, LOS, and total charges were curvilinearly related with BMI (all p < 0.05). Total hospital charges were highest in the severely obese group compared with the overweight group (p < 0.05). Non‐homebound discharge disposition rates were lower in non‐obese (13.1%) and severely obese groups (10.5%). Discussion: Elevated BMI does not prevent FIM gains in THA patients during inpatient rehabilitation. However, BMI is related with FIM efficiency, LOS, and hospital charges in a curvilinear fashion. Severely obese patients can achieve physical improvements but at a lower efficiency and greater cost.     

The number of satellite cells in slow and fast fibres from human vastus lateralis muscle

The aim of this investigation was to study the distribution of satellite cells in slow (type I fibres) and fast (type II fibres) fibres from human vastus lateralis muscle. This muscle is characterised by a mixed fibre type composition and is considered as the site of choice for biopsies in research work and for clinical diagnosis. Biopsy samples were obtained from five healthy young volunteers and a total of 1,747 type I fibres and 1,760 type II fibres were assessed. Satellite cells and fibre type composition were studied on serial muscle cross-sections stained with specific monoclonal antibodies. From a total of 218 satellite cells, 116 satellite cells were found in contact with type I fibres (53.6±8% of the satellite cells associated to type I fibres) and 102 satellite cells in contact with type II fibres (46.4±8% of the satellite cells associated to type II fibres). There was no significant difference (P=0.4) between the percentages of satellite cells in contact with type I and with type II fibres. Additionally, there was no relationship between the mean number of satellite cells per fibre and the mean cross-sectional area of muscle fibres. In conclusion, our results show that there is no fibre type-specific distribution of satellite cells in a human skeletal muscle with mixed fibre type composition.     

Subject-specific musculoskeletal modelling in patients before and after total hip arthroplasty*

The goal of this study was to define the effect on hip contact forces of including subject-specific moment generating capacity in the musculoskeletal model by scaling isometric muscle strength and by including geometrical information in control subjects, hip osteoarthritis and total hip arthroplasty patients. Scaling based on dynamometer measurements decreased the strength of all flexor and abductor muscles. This resulted in a model that lacked the capacity to generate joint moments required during functional activities. Scaling muscle forces based on functional activities and inclusion of MRI-based geometrical detail did not compromise the model strength and resulted in hip contact forces comparable to previously reported measured contact forces.     

Quality of the blood sampled from surgical drainage after total hip arthroplasty

Several methods have been found to be successful in reducing the need for allogeneic transfusion among the patients undergoing total hip replacement. The purpose of this prospective study was to analyse the quality and evaluate the effect of postoperative autotransfusion on the need for allogeneic transfusion following total hip replacement. The prospective study was performed in two groups of patients undergoing total hip replacement. Before the operative procedure all patients in both groups predonated two doses of autologous blood. In GROUP 1. the system for postoperative collection and transfusion of shed blood was used. In GROUP 2. the patients underwent total hip replacement without blood salvage system. Standard suction collection sets were used postoperatively. In this group shed blood was not transfused to the patients. The samples of preoperative donated autologus blood, allogeneic blood and postoperative collected autologous blood were analysed for number of red cells, hemoglobin, hematocrit, platelets, white blood cells, values of potassium, sodium, free hemoglobin and acid base status. The postoperatively blood salvage significantly reduced the use of allogeneic transfusion among patients managed with total hip replacement (allogeneic transfusion received 12% patients in Group 1 and 80% patients in Group 2; p<0.001). The values of red blood cells are significantly lower in postoperative collected autotransfusion blood compared with preoperative collected autologous blood and allogeneic blood (p<0.001). The values of potassium and acid base status were in normal range in postoperatively collected autotransfusion blood. These values in preoperatively collected autologous blood and allogeneic blood were out of normal range; (p<0.001). In addition to reducing the risk of complications that are associated with allogeneic transfusion, postoperative blood salvage may offer benefits including reducing the need for allogeneic blood. Our study confirmed that postoperative collection and transfusion of drainaged blood is simple and safe method that significantly reduce the need for allogeneic transfusion in patients underwent total hip replacement. The blood collected and transfused postoperatively has lower values of red blood cells and normal values of potassium and acid base balance. The transfusion of this blood caused no complications in our patients.     

Changes in structure and metabolism in the m. vastus lateralis in monkeys after a space flight

Monkeys developed a significant reduction in size of the m. vastus lateralis' fast and slow fibres, the amount of protein in them remaining the same.