Patients who are forced to rest or reduce activity as a result of illness, injury, or
surgery often experience resulting muscle weakness. This study will evaluate muscle
features and muscle strength in patients who are recovering from surgery for broken ankles.
The goal of this study is to improve the recovery of muscle function and overall ability
after prolonged periods of ankle inactivity due to surgery.
Many physiological conditions are associated with muscle weakness and can affect movement.
This study will investigate which metabolic and morphological features of skeletal muscle
are uniquely altered during the course of rehabilitation and how they affect muscle function
and performance in daily ambulatory activities. This study will also examine how well the
commonly used assessment measures reflect actual muscle capacity. Finally, because there is
evidence that activity does not affect all fiber types uniformly, fiber-type specific
metabolic and morphological measures will be performed.
Participants in this study will have had an ankle injury that has been treated surgically
(Open Reduction Internal Fixation, or ORIF) followed by 5 to 10 weeks of cast
immobilization. Following initial baseline measurements made after 1 week of re-ambulation,
participants are enrolled in a 10-week rehabilitation program that focuses on restoration of
both muscle strength and endurance. Assessments are made at Weeks 5 and 10 and include
31P-Magnetic Resonance Spectroscopy (MRS), Magnetic Resonance Imaging (MRI), muscle biopsy,
and muscle function and functional performance tests. 31P-measurements monitor changes in
the in vivo metabolic characteristics of skeletal muscle. 3D-MRI procedures will be used to
quantify the maximal muscle cross-sectional area and total muscle volume. Muscle endurance
and strength will be measured using an isokinetic dynamometer. Functional performance tests
consist of self-selected walking pace, power for ascending and descending stairs, and toe
raises while standing on one foot.
Nine participants (six patients and three control volunteers) will be studied each year.
Control volunteers are submitted to the same measurements at similar time intervals in order
to assess variability over time.
- 5 to 10 weeks of cast immobilization following surgery (ORIF) for mallerolar fracture
- Pregnant or breastfeeding
- Severe claustrophobia
- MRI incompatible metal implants (e.g., pacemaker)
- Diabetes or peripheral neuropathies
- Bleeding disorders
Krista Vandenborne, Ph.D., P.T.
University of Pennsylvania, Department of Physiology