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|Blood flow restriction therapy for two weeks prior to anterior cruciate ligament reconstruction did not impact quadriceps strength compared to standard therapy|
|Tramer JS, Khalil LS, Jildeh TR, Abbas MJ, McGee A, Lau MJ, Moutzouros V, Okoroha KR|
|Arthroscopy 2022 Jul 14:Epub ahead of print|
|7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*|
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.