'Real world' clinical implementation of blood flow restriction therapy does not increase quadriceps strength after quadriceps tendon autograft ACL reconstruction

Zachary J Herman; Justin J Greiner; Janina Kaarre; Nicholas P Drain; Jonathan D Hughes; Bryson P Lesniak; James J Irrgang; Volker Musahl

doi:10.1002/ksa.12217

'Real world' clinical implementation of blood flow restriction therapy does not increase quadriceps strength after quadriceps tendon autograft ACL reconstruction

Knee Surg Sports Traumatol Arthrosc. 2024 Apr 30. doi: 10.1002/ksa.12217. Online ahead of print.

Authors

Zachary J Herman¹, Justin J Greiner², Janina Kaarre^{1

3}, Nicholas P Drain¹, Jonathan D Hughes¹, Bryson P Lesniak¹, James J Irrgang^{1

4}, Volker Musahl¹

Affiliations

¹ Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
² University of Nebraska Medical Center, Omaha, Nebraska, USA.
³ Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
⁴ Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA.

PMID: 38686588
DOI: 10.1002/ksa.12217

Abstract

Purpose: To retrospectively compare strength outcomes of individuals undergoing postoperative rehabilitation following quadriceps tendon (QT) autograft anterior cruciate ligament reconstruction (ACLR) with and without blood flow restriction therapy.

Methods: A retrospective review of consecutive patients undergoing ACLR with QT autograft with a minimum of two quantitative postoperative isometric strength assessments via an electromechanical dynamometer (Biodex) was included. Demographics, surgical variables and strength measurement outcomes were compared between patients undergoing blood flow restriction therapy as part of postoperative rehabilitation versus those who did not.

Results: Eighty-one (81) patients met the inclusion criteria. No differences were found in demographic and surgical characteristics between those who received blood flow restriction compared with those who did not. While both groups had improvements in quadriceps peak torque and limb symmetry index (LSI; defined as peak torque of the operative limb divided by the peak torque of the nonoperative limb) over the study period, the blood flow restriction group had significantly lower mean peak torque of the operative limb at first Biodex strength measurement (95.6 vs. 111.2 Nm; p = 0.03). Additionally, the blood flow restriction group had a significantly lower mean LSI than those with no blood flow restriction at the second Biodex measurement timepoint (81% vs. 90%; p = 0.02). No other significant differences were found between the strength outcomes measured.

Conclusions: Results of this study show that the 'real world' clinical implementation of blood flow restriction therapy to the postoperative rehabilitation protocol following QT autograft ACLR did not result in an increase in absolute or longitudinal changes in quadriceps strength measurements. A better understanding and standardisation of the use of blood flow restriction therapy in the rehabilitation setting is necessary to delineate the true effects of this modality on strength recovery after QT autograft ACLR.

Level of evidence: Level III.

Keywords: ACL (anterior cruciate ligament) reconstruction; Biodex; blood flow restriction therapy; knee extension strength.

Grants and funding

None