Ultrasonographic Identification of Muscle Atrophy in Hamstring Muscles after Anterior Cruciate Ligament Repair among Soccer Players: A Case-control Study

Objectives: To measure the CSA of the HST musculature measured with ultrasonography in soccer players undergoing ACLR and compare limb differences with healthy controls. Methods: A case-control study was performed with patients after anterior cruciate ligament repair (ACLR) and healthy controls in which cross-sectional areas (CSA) obtained using a model TE7 ultrasound machine (MINDRAY ®, USA) in B mode (4.2 to 13 MHz) with a multifrequency linear array transducer (L12-4S). Three CSA images were taken of the semitendinosus muscle (ST) and the long head of the biceps femoris (BFlh), at a distance of 30% and 70% of the ischial tuberosity insertion. Mean differences between groups were analyzed using SPSS v.20 (IBM®, USA), and statistical analyses were performed using non-parametric techniques to determine differences between groups (Student's t-test) and Cohen's correlation coefficient to quantify effect size. Results: 14 ACLR operated 17 ± 5.4 months ago and 12 healthy controls (W = 6; M = 20M; 24.5 ± 3.92 years; BMI = 25.1 ± 2.32 kg/m²) were recruited. There were differences between groups in CSA-ST70 (Post-ACLR = 1.43 ± 1.029 cm² vs Control 2.65 ± 0.664 cm², T Student = -3.68, 95% CI [-Inf, -0.648], P < 0. 001, ES = -1.418), but not in CSA-ST30 (Post-ACLR = 8.42 ± 1.596 cm² vs Control 9.16 ± 0.945 cm², T Student = -1.535; 95% CI [-Inf, -0.0793], P = 0. 068, ES = -0.5607), CSA-BFlh30 (Post-ACLR = 8.79 ± 1.47 cm² vs Control 8.87 ± 2.312 cm², T Student = -0.123; 95% CI [-Inf, 1.1049], P = 0.452, ES = -0. 049) or CSA-BFlh70 (Post-ACLR = 6.91 ± 1.011 cm² vs Control 7.01 ± 1.453 cm², T Student = -0.214; 95% CI [-Inf, 0.6795], P = 0.416, ES = -0.0783). Conclusion: Ultrasound measurement of the CSA can be an image marker to identify muscle weakness or atrophy that predicts functional loss early.