Blood flow restriction added to usual care exercise in patients with early weight bearing restrictions after cartilage or meniscus repair in the knee joint: a feasibility study

Thomas Linding Jakobsen, Kristian Thorborg, Jakob Fisker, Thomas Kallemose, Thomas Bandholm, Thomas Linding Jakobsen, Kristian Thorborg, Jakob Fisker, Thomas Kallemose, Thomas Bandholm

Abstract

Purpose: Blood flow restriction - low load strength training (BFR-LLST) is theoretically superior to traditional heavy strength training when rehabilitating patients who cannot heavily load tissues following surgery. The main purpose of this study was to examine the feasibility of BFR-LLST added to usual care exercise early after cartilage or meniscus repair in the knee joint.

Methods: We included 42 patients with cartilage (n = 21) or meniscus repair (n = 21) of the knee joint. They attended 9 weeks of BFR-LLST added to a usual care exercise program at an outpatient rehabilitation center. Outcome measures were assessed at different time points from four (baseline) to 26 weeks postoperatively and included adherence, harms, knee joint and thigh pain, perceived exertion, thigh circumference (muscle size proxy), isometric knee-extension strength, self-reported disability and quality of life.

Results: On average, patients with cartilage or meniscus repair completed > 84% of the total BFR-LLST supervised sessions. Thirty-eight patients reported 146 adverse events of which none were considered serious. No decrease in thigh circumference or exacerbation of knee joint or quadriceps muscle pain of the operated leg was found in either group during the intervention period.

Conclusions: BFR-LLST added to usual care exercise initiated early after cartilage or meniscus repair seems feasible and may prevent disuse thigh muscle atrophy during a period of weight bearing restrictions. Harms were reported, but no serious adverse events were found. Our findings are promising but need replication using a RCT-design.

Trial registration: NCT03371901 , preprint (open access): https://www.medrxiv.org/content/10.1101/2022.03.31.22272398v1.

Keywords: Blood flow restriction exercise; Cartilage; Feasibility studies; Meniscus; Rehabilitation; Surgery.

Conflict of interest statement

The authors have declared that no competing interests exist, except TB, who declares: I have received speaker’s honoraria for talks or expert testimony on the efficacy of exercise therapy to enhance recovery after surgery at meetings or symposia held by biomedical companies (Zimmer Biomet and Novartis). I have received fees for writing textbook chapters (Munksgaard) and for organising post-graduate education, such as post-graduate courses in clinical exercise physiology (Danish Physical Therapy Organization) or PhD courses on clinical research methodology (University of Copenhagen). I am an editorial board member with Br J Sports Med. I am an exercise physiologist and physical therapist and may have a cognitive exercise bias.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Overview of study treatment, testing and assessment timeline. Uncontrolled; Treatment provided prior to study inclusion or after the intervention period. SOS-R; Section for Orthopedic and sports Rehabilitation. BFR-LLST; Blood flow restriction – low load strength training
Fig. 2
Fig. 2
Patient flow diagram
Fig. 3
Fig. 3
Scores of each patient and mean scores for the patients with cartilage (black dots and line) or meniscus repair (gray dots and line) over time for thigh circumference (A), knee joint pain (B) and perceived exertion (C) during the BFR-LLST intervention. BFR-LLST; Blood flow restriction – low load strength training. VAS; Visual Analogue Scale
Fig. 4
Fig. 4
Knee joint pain (A), quadriceps muscle pain (B) and perceived exertion (C) from the first to the fourth set within the BFR-LLST supervised session (15 sessions each) for all patients. Scatterplots with means including whiskers representing 95% confidence intervals

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