Does blood flow restriction training improve outcomes after ACL reconstruction?

It is well accepted that the main aim of an ACL reconstruction (ACLR) rehabilitation programme is to return patients to their pre-injury level of function with the lowest risk of re-injury. Post-surgery, players will usually experience a significant loss of lower limb strength due to muscle atrophy and inhibition mechanisms. This FastFact highlights a blinded, randomised controlled trial comparing the use of blood flow restriction training (BFR-RT) with standard therapy (HL-RT) for the rehabilitation of patients following ACLR1.

ACL rehabilitation protocols generally involve heavy load resistance training (HL-RT) to stimulate skeletal muscle hypertrophy and strength adaptations. Unfortunately, this type of rehabilitation can be poorly tolerated by some patients, especially those with concomitant meniscal, chondral or bone injuries. Blood flow restriction (BFR) resistance training (BFR-RT) has been proposed as a possible alternative option for these patients. This type of training has been shown to elicit muscle hypertrophy and strength adaptations in load-compromised populations using much lighter loads. In addition, BFR-RT can reduce pain and improve general physical function.

This study highlighted in this FastFact is a blinded randomized controlled trial comparing the use of BFR-RT vs. HL-RT in 28 subjects who underwent ACLR surgery with hamstring autograft. The intervention included an 8-week programme of unilateral leg press within a standardised rehabilitation programme. The HL-RT group trained at 70% of 1 repetition maximum (RM) while the BFR-RT group trained at only 30% of 1RM. Results at nine weeks showed that both BFR-RT and HL-RT elicited comparable increases in skeletal muscle hypertrophy and strength. Interestingly, BFR-RT resulted in greater improvements in physical function, range of motion and greater reduction in pain and effusion. Of note, there were no adverse events or effects with either intervention.

This study highlights the potential value of BFR and its role as a tool in post-operative rehabilitation after ACL reconstruction surgery. While this study focused on BFR allowing therapists to work with patients who are “knee load compromised” after ACL reconstruction, it is possible that applying BFR therapies with different protocols and regimens can introduce many more benefits. It is important to highlight the relatively small number of participants in this study and the need to confirm the study’s findings in a larger cohort of patients.

To learn more about injuries to the anterior cruciate ligament complete the ACL modules in the FIFA Diploma in Football Medicine.

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SharonWAtwarCEBIC SINISAAndressa Rafaeli ViecelliLuke Hughes Recent comment authors
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Majd_B
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Majd_B

Thanks alot

Majd_B
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Majd_B

Thanks a lot

Steven Griffith
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Steven Griffith

I really like this and the outcome, but please, this is not a small study, a study is big when your in it, it validates several points, the job is well done, we don’t need bigger anymore, we need variety, we clinicians need variety and something we can sink our teeth in, we can choose either heavy or light load for patient flexibility. Its just good all round. Thank you for doing it

Luke Hughes
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Luke Hughes

Thanks Steven, plenty of content and it was a good one to get out.

Necko
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Necko

Nice 👍😃

Andressaviecelli
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Andressaviecelli

How and in what week do they measure strenght?

CEBIC SINISA
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CEBIC SINISA

Hello! I think is a interesting trening. What time I start after acl reconstruction.

Atwar
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Atwar

Does anyone have the full pdf for this ? I am unable to access it via springer.

SharonW
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SharonW

Any strength training should be bilateral – not unilateral, despite the fact that the injury is only on one side. That way a balanced rehab will occur and there will be far less likelihood of secondary spinal strain/subluxation.