Purpose
To evaluate the efficacy of a 2-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 using 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 2 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 and 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% vs 64% male [P = .271] and average age 26.5 ± 12.0 vs 27.0 ± 11.0 [P = .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 > .05 for all). Following completion of a 2-week home prehabilitation protocol, all
patients indeterminant of cohort demonstrated decreased strength loss in the operative
leg compared to the nonoperative leg (P < .05 for both) However, there were no significant differences in any strength or
outcome measures between the BFR and control groups (P > .05 for all). There were no complications experienced in either group, and both
were compliant with the home-based prehabilitation program.
Conclusions
A 2-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.
Level of Evidence
Level II, randomized controlled trial with small effect size
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Article info
Publication history
Published online: July 13, 2022
Accepted:
June 23,
2022
Received:
February 11,
2022
Footnotes
See commentary on page 382
ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
