Side Effects and Patient Tolerance with the Use of Blood Flow Restriction Training after ACL Reconstruction in Adolescents: A Pilot Study

Jennifer Prue, Dylan P Roman, Nicholas G Giampetruzzi, Arthur Fredericks, Adel Lolic, Allison Crepeau, J Lee Pace, Adam P Weaver, Jennifer Prue, Dylan P Roman, Nicholas G Giampetruzzi, Arthur Fredericks, Adel Lolic, Allison Crepeau, J Lee Pace, Adam P Weaver

Abstract

Background: Blood flow restriction training (BFRT) has gained popularity in rehabilitation due to its benefits in reducing muscle atrophy and mitigating strength deficits following anterior cruciate ligament reconstruction (ACLR). While the effectiveness and safety of BFRT has been well studied in healthy adult subjects, there is limited information about the use of BFRT in the adolescent population, specifically related to patient tolerance and reported side effects post ACLR.

Purpose: To investigate and record reported side effects and patient tolerance to BFRT during ACLR rehabilitation in adolescents.

Study design: Prospective Cohort Study.

Methods: Patients between 12 and 18 years of age who underwent ACLR at Connecticut Children's were included. Patients utilized an automatic personalized tourniquet system and followed a standardized BFRT exercise protocol over 12 weeks starting 8.72 ± 3.32 days post-op. Upon completion of exercise while using BFRT, patients reported side effects and any adverse events were logged. Descriptive statistics were used to describe the reported side effects and adverse events associated with BFRT and calculate the frequencies of those events over a 12-week period.

Results: Five hundred and thirty-five total BFRT sessions were completed between 29 patients (15.39 ± 1.61 years of age). There were zero reports of subcutaneous hemorrhage (SubQ hemorrhage) and deep vein thrombosis (DVT). Reported minor side effects to BFRT included itchiness of the occluded limb (7.85%), lower extremity paresthesia (2.81%), and dizziness (0.75%). A total of 10.47% of BFR treatment sessions were unable to be completed due to tolerance, and 3.5% of sessions required a reduction in limb occlusion pressure (LOP).

Conclusion: These preliminary data suggest that BFRT is safe with only minor side effects noted in the adolescent population after ACLR. Further investigations are warranted to continue to evaluate patient tolerance and safety with BFRT, because while these preliminary results suggest a positive safety profile and good tolerance in the adolescent population after ACLR, they represent the experiences of only a small sample.

Level of evidence: Level 3.

Keywords: ACL; Blood Flow Restriction; Patient Tolerance; Reported Side Effects; Safety.

Conflict of interest statement

JP, DR, NG, AL and AW have no conflicts of interest to disclose. AC has a leadership role for Pro Papa Missions America, Pediatric Orthopedic Society of North America, and Pediatric Research in Sports Medicine. JLP receives consulting fees and grants from Arthrex, JRF Ortho, and the American Orthopedic Society for Sports Medicine.

Figures

Figure 1.. Patients unable to complete prescribed…
Figure 1.. Patients unable to complete prescribed 12 weeks of BFRT

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