{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T19:26:08Z","timestamp":1793820368761,"version":"4.6.1"},"reference-count":30,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"national institutes of health","doi-asserted-by":"publisher","award":["NIH award KL2TR002374"],"award-info":[{"award-number":["NIH award KL2TR002374"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000090","name":"congressionally directed medical research programs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000090","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Peer Reviewed Orthopaedic Research Program","award":["Peer Reviewed Orthopaedic Research Program (PRORP)"],"award-info":[{"award-number":["Peer Reviewed Orthopaedic Research Program (PRORP)"]}],"id":[{"id":"https:\/\/ror.org\/03573qv54","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Preoperative quadriceps and hamstring muscle weakness may predispose patients to strength deficits and prolonged recovery in the setting of anterior cruciate ligament (ACL) injury. Three-dimensional (3D) magnetic resonance imaging (MRI) analysis has been developed to provide a comprehensive assessment of the thigh musculature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To (1) describe the magnitude of quadriceps and hamstring muscle weakness relative to the uninjured limb preoperatively in patients with known ACL tears, and (2) determine if preoperative quadriceps and hamstring muscle volume correlate with quadriceps knee extension strength and hamstring knee flexion strength.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cross-sectional study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Patients undergoing primary ACL reconstruction (ACLR) underwent MRI scans of the bilateral lower extremities and strength testing preoperatively within 7 days of ACLR. Three-dimensional MRI\u2013based autosegmentation was used to measure the volume of individual quadriceps and hamstring muscles. Preoperative knee extension and flexion strength were assessed isometrically at 90\u00b0 and isokinetically. Linear mixed-effects models were used to assess muscle volume by limb interaction effect on strength. Pearson correlation coefficients (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      ) were used to assess the association between muscle volume and strength in the injured and uninjured limbs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In total, 72 patients were included (mean age, 26.6 \u00b1 8.8 years; 64% male) with the median time to preoperative strength assessment and MRI within 90 days of injury. Comparing the ACL-injured limb to the uninjured limb, isometric knee extension and flexion strength demonstrated mean limb symmetry indices (LSIs) of 80.1% \u00b1 18.5% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and 83.7% \u00b1 17.7% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), respectively. Additionally, measured quadriceps and hamstring volume demonstrated mean LSIs of 89.9% \u00b1 8.8% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and 95.4% \u00b1 4.6% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), respectively. There was moderate to strong positive associations between individual muscle volume and strength in both the injured and uninjured limbs, regardless of the mode of strength assessment (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.43-0.84; all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Preoperatively, a 20% deficit in isometric knee extension strength and a 10% deficit in quadriceps muscle volume was noted in the ACL-injured knee compared to the uninjured limb. A moderate to strong correlation between quadriceps strength and each individual quadriceps muscle volume measured by a 3D MRI platform was observed before ACLR. Findings suggest the utility of automated 3D MRI volumetric segmentation as an adjunct to complement formal preoperative strength assessment. Additionally, this method may be used to identify patients at risk for delayed and\/or degraded functional outcomes after ACLR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465261456991","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T09:35:04Z","timestamp":1782725704000},"page":"2407-2416","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["MRI-Based Volumetric Analysis of the Quadriceps Muscles Correlation With Knee Extension Strength in Patients Undergoing Anterior Cruciate Ligament Reconstruction"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3164-1615","authenticated-orcid":false,"given":"Mikalyn T.","family":"DeFoor","sequence":"first","affiliation":[{"name":"The Steadman Clinic and Steadman Philippon Institute, Vail, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0922-6332","authenticated-orcid":false,"given":"Keith A.","family":"Knurr","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin\u2013Madison, Madison, Wisconsin, USA"},{"name":"Badger Athletic Performance Program, University of Wisconsin\u2013Madison, Madison, Wisconsin, USA"},{"name":"Doctor of Physical Therapy Program, University of Wisconsin\u2013Madison, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Heiderscheit","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin\u2013Madison, Madison, Wisconsin, USA"},{"name":"Badger Athletic Performance Program, University of Wisconsin\u2013Madison, Madison, Wisconsin, USA"},{"name":"Doctor of Physical Therapy Program, University of Wisconsin\u2013Madison, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Riem","sequence":"additional","affiliation":[{"name":"Springbok Analytics, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Cognetti","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas, USA"},{"name":"United States Army Institute of Surgical Research, San Antonio, Texas, USA"},{"name":"Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6000-8948","authenticated-orcid":false,"given":"Joshua","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas, USA"},{"name":"The Henry M. 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