In vivo muscle architecture and size of the rectus femoris and vastus lateralis in children and adolescents with cerebral palsy

Aim: Our aimwas to investigate muscle architecture and size of the rectus femoris (RF) and vastus lateralis (VL) in children and adolescents with cerebral palsy (CP) compared with age-matched typically developing participants. Method: Muscle architecture and size were measured with ultrasound imaging in 18 participants with spastic CP (9 females, 9 males; age range 7.5-19y; mean age 12y [SD 3y 2mo]) within Gross Motor Function Classification System levels I (n=4), II (n=2), III (n=9), and IV (n=3) and 12 typically developing participants (10 females, 2males; age range 7-20y; mean age 12y 4mo [SD 3y 11mo]). Exclusion criteria were orthopedic surgery or neurosurgery within 6 months before testing or botulinum toxin injections to the quadriceps within 3 months before testing. Results: RF cross-sectional area was significantly lower (48%), RF and VL muscle thickness 30% lower, RF fascicle length 27% lower, and VL fascicle angle 3° less in participants with CP compared to the typically developing participants (p<0.05). Intraclass correlation coefficients were ≥ 0.93 (CP) and ≥ 0.88 (typical development), indicating excellent reliability. Interpretation: These results provide the first evidence of altered muscle architecture and size of the RF and VL in CP, similar to patterns observed with disuse and aging. These alterations may play a significant role in the decreased capacity for force generation as well as decreased shortening velocity and range of motion over which the quadriceps can act.