Muscle Atrophy After ACL Reconstruction Involves Molecular Mechanisms Beyond Unloading, 2026, Keeble et al.

SNT Gatchaman

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Muscle Atrophy After ACL Reconstruction Involves Molecular Mechanisms Beyond Unloading
Alexander R Keeble; Sara Gonzalez-Velez; Nicholas T Thomas; Allison M Owen; Austin V Stone; Darren L Johnson; Julián Candia; Luigi Ferrucci; Marco Narici; Esther E Dupont-Versteegden; Brian Noehren; Martino V Franchi; Christopher S Fry

Anterior cruciate ligament reconstruction (ACLR) leads to profound muscle atrophy and weakness that remain resistant to rehabilitation. Although early recovery typically involves a brief period of limb unloading, the degree to which disuse alone accounts for muscle pathology after ACLR remains unclear.

Here, we leveraged publicly-available RNA-seq datasets of muscle biopsies from vastus lateralis obtained seven days after ACLR or ten days after unilateral lower limb suspension (ULLS), each with matched control limbs, to directly compare disuse-driven and ACLR-specific early transcriptional responses.

Despite similar periods of reduced loading, substantial transcriptomic divergence was identified using both intersection and interaction bioinformatic analyses. Only 16% of differentially expressed genes (DEGs) were common to both ACLR and ULLS, with ACLR eliciting over 1,000 more DEGs than ULLS. ACLR was characterized by reduced extracellular matrix (ECM) remodeling and robust induction of denervation-responsive genes which were not observed with unloading alone.

These findings indicate that unloading contributes only modestly to the early muscle transcriptomic response following ACLR. Identifying potential ACLR-specific molecular effectors of atrophy advances our understanding of its unique pathophysiology that may underlie poorer functional recovery.

Web | DOI | PDF | Journal of Applied Physiology | Open Access
 
Taken together, these findings suggest that rapid neuromuscular remodeling after ACLR is likely multimodal, with disuse contributing to ACLR-related neuromuscular adaptations rather than serving as the primary effector.

Notably, reductions in genes related to extracellular matrix (ECM) remodeling were specific to ACLR, as demonstrated by our intersection, interaction, and deconvolution analyses.

Disuse is frequently cited as a primary effector of quadriceps pathology following ACLR. Here, we demonstrate substantial transcriptional differences between a model of unilateral unloading disuse and ACLR that emerge over similar temporal periods. Our findings implicate ACLR-induced muscle atrophy as biologically distinct from disuse and underscore the need for rehabilitation strategies tailored specifically to the unique molecular consequences of ACLR.
 
Potentially a very interesting area. Presumably when ACL is damaged and especially when repaired there will be damage to nerves involved in proprioceptive loops that control servo mechanisms used in muscle contraction. Gamma efferent signals to muscle may be in complete disarray.

I was horrified when the US female downhill skier tried to compete a few days after ligament injury for this very reason. Apparently she manage to get good times in trial runs but things were bound to be out of kilter under race conditions.

Not sure how it would fit in with an ME/CFS muscle control failure story but all this stuff is potentially fascinating.
 
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