Abstract
Purpose
To evaluate the efficacy of a two-week home-based blood flow restriction (BFR) prehabiliation
program on quadriceps strength and patient reported outcomes prior to anterior cruciate
ligament (ACL) reconstruction.
Methods
Patients presenting with an ACL tear were randomized into two groups, BFR and control,
at their initial clinic visit. Quadriceps strength was measured utilizing a handheld
dynamometer in order to calculate peak force, average force and time to peak force
during seated leg extension at the initial clinic visit and repeated on the day of
surgery. All patients were provided education on standardized exercises to be performed
5 days per week for two weeks between the initial clinic visit and date of surgery.
The BFR group was instructed to perform these exercises with a pneumatic cuff set
to 80% of limb occlusion pressure placed over the proximal thigh. Patient Reported
Outcome Measurement System Physical Function (PROMIS-PF), knee range of motion and
quadriceps circumference were gathered at the initial clinic visit /day of surgery
and patients were monitored for adverse effects.
Results
A total 45 patients met inclusion criteria and elected to participate. There were
23 patients randomized to the BFR group and 22 patients randomized into the control
group. No significant differences were noted between the BFR and control groups in
any demographic characteristics (48% versus 64% male (p=0.271) and average age 26.5
± 12.0 versus 27.0 ± 11.0 (p=0.879) in BFR and control respectively). During the initial
clinic visit there were no significant differences in quadriceps circumference, peak
quadriceps force generation, time to peak force, average force, pain and PROMIS scales
(P>0.05 for all). Following completion of a two week home prehabilitation protocol
all patients indeterminant of cohort demonstrated decreased strength loss in the operative
leg compared to the non-operative leg (p<0.05 for both) However, there were no significant
differences in any strength or outcome measures between the BFR and control groups
(P>0.05 for all). There were no complications experienced in either group, and both
were compliant with the home-based prehabilitation program.
Conclusions
A two week standardized prehabilitation protocol preceding ACL reconstruction resulted
in a significant improvement in personal quadriceps peak force measurements, both
with and without the use of BFR. No difference in quadriceps circumference, strength,
or patient reported outcomes were found between the BFR and the control group. The
home-based BFR prehabiliation protocol was found to be feasible, accessible, and well
tolerated by patients.
Key Words
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Article Info
Publication History
Accepted:
June 23,
2022
Received in revised form:
June 14,
2022
Received:
February 11,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Study investigation performed at Henry Ford Hospital, Detroit, MI, and approved by Henry Ford Hospital Institutional Review Board
Author Contributions JT, LK, MA, TJ, ML, and AM carried out the literature review, developed the protocol and created the data collection tool. VM and KO reviewed the protocol and excel database for errors. JT, LK, MA, TJ, and AM conducted data collection and documentation into the database. ML assisted with development of prehabilitation protocol, and provided patient education tools to ensure adherence to the therapy protocol. All authors contributed towards detailing the statistical analysis request, analysing the results, and synthesizing tables and figures as well as drafting the manuscript. All authors contributed to multiple revisions of the manuscript. VM and KO are the attending physicians who approved each step of the study, reviewed the literature cited and statistical analysis requested, revised each draft of the manuscript, and provided mentorship throughout the course of the study. All authors read and approved the final manuscript.
Level of Evidence: Level 2: Randomized Controlled Trial With Small Effect Size
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
