Blood Flow Restriction Training Can Improve Peak Torque Strength in Chronic Atrophic Postoperative Quadriceps and Hamstrings Muscles


      To report a prospective study of patients who underwent blood flow restriction training (BFRT) for marked quadriceps or hamstring muscle deficits after failure to respond to traditional rehabilitation after knee surgery.


      The BFRT protocol consisted of 4 low resistance exercises (30% of 1 repetition maximum): leg press, knee extension, mini-squats, and hamstring curls with 60% to 80% limb arterial occlusion pressure. Knee peak isometric muscle torque (60° flexion) was measured on an isokinetic dynamometer.


      Twenty-seven patients (18 females, 9 males; mean age, 40.1 years) with severe quadriceps and/or hamstrings deficits were enrolled from April 2017 to January 2020. They had undergone a mean of 5.3 ± 3.5 months of outpatient therapy and 22 ± 10 supervised therapy visits and did not respond to traditional rehabilitation. Prior surgery included anterior cruciate ligament reconstruction, partial or total knee replacements, meniscus repairs, and others. All patients completed 9 BFRT sessions, and 14 patients completed 18 sessions. The mean quadriceps and hamstrings torque deficits before BFRT were 43% ± 16% and 38% ± 14%, respectively. After 9 BFRT sessions, statistically significant improvements were found in muscle peak torque deficits for the quadriceps (P = .003) and hamstring (P = .02), with continued improvements after 18 sessions (P = .004 and P = .002, respectively). After 18 BFRT sessions, the peak quadriceps and hamstring peak torques increased > 20% in 86% and 76% of the patients, respectively. The failure rate of achieving this improvement in peak quadriceps and hamstring torque after 18 BFRT sessions was 14% and 24%, respectively.


      BFRT produced statistically significant improvements in peak quadriceps and hamstring torque measurements after 9 and 18 sessions in a majority of patients with severe quadriceps and hamstring strength deficits that had failed to respond to many months of standard and monitored postoperative rehabilitation.

      Level of Evidence

      Level IV therapeutic case series.
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