Background: Quadriceps muscle atrophy remains a limiting factor in returning to activity after anterior cruciate ligament reconstruction (ACLR). Blood flow restriction (BFR) therapy may accelerate quadriceps strengthening in the perioperative period.
Purpose: To evaluate postoperative isometric quadriceps strength in patients who underwent ACLR with a perioperative BFR program.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: Patients indicated for ACLR were randomized into 2 groups, BFR and control, at their initial clinic visit. All patients underwent 2 weeks of prehabilitation preoperatively, with the BFR group performing exercises with a pneumatic cuff set to 80% limb occlusion pressure placed over the proximal thigh. All patients also underwent a standardized postoperative 12-week physical therapy protocol, with the BFR group using pneumatic cuffs during exercise. Quadriceps strength was measured as peak and mean torque during seated leg extension and presented as quadriceps index (percentage vs healthy limb). Patient-reported outcomes (PROs), knee range of motion, and quadriceps circumference were also gathered at 6 weeks, 3 months, and 6 months postoperatively, and adverse effects were recorded.
Results: Included were 46 patients, 22 in the BFR group (mean age, 25.4 ± 10.6 years) and 24 in the control group (mean age, 27.5 ± 12.0 years). At 6 weeks postoperatively, the BFR group demonstrated significantly greater strength compared with the controls (quadriceps index: 57% ± 24% vs 40% ± 18%; P = .029), and the BFR group had significantly better Patient-Reported Outcomes Measurement Information System-Physical Function (42.69 ± 5.64 vs 39.20 ± 5.51; P = .001) and International Knee Documentation Committee (58.22 ± 7.64 vs 47.05 ± 13.50; P = .011) scores. At 6 weeks postoperatively, controls demonstrated a significant drop in the peak torque generation of the operative versus nonoperative leg. There were no significant differences in strength or PROs at 3 or 6 months postoperatively. Three patients elected to drop out of the BFR group secondary to cuff intolerance during exercise; otherwise, no other severe adverse events were reported.
Conclusion: Integrating BFR into perioperative physical therapy protocols led to improved strength and increased PROs at 6 weeks after ACLR. No differences in strength or PROs were found at 3 and 6 months between the 2 groups.
Registration: NCT04374968 (ClinicalTrials.gov identifier).
Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: K.R.O. has received grant support from Arthrex; education payments from Arthrex, Endo Pharmaceuticals, and Smith & Nephew; nonconsulting fees from Arthrex and Smith & Nephew; consulting fees from Endo Pharmaceuticals and Smith & Nephew; honoraria from Wright Medical; and hospitality payments from Medical Device Business Services, Stryker, and Zimmer Biomet. J.S.T. has received education payments from Pinnacle. L.S.K. has received education payments from Pinnacle and Medwest Associates. T.R.J. has received consulting fees from Biogen; hospitality payments from Exactech and Zimmer Biomet; and education payments from DePuy Synthes, Pinnacle, and Smith & Nephew. V.M. has received consulting fees from Pacira Pharmaceuticals and education payments from Pinnacle. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Henry Ford Hospital (No. 13080).
(© The Author(s) 2023.)