Blood Flow Restriction Therapy After Knee Surgery: Indications, Safety Considerations, and Postoperative Protocol

Nicholas N DePhillipo, Mitchell I Kennedy, Zachary S Aman, Andrew S Bernhardson, Luke O'Brien, Robert F LaPrade, Nicholas N DePhillipo, Mitchell I Kennedy, Zachary S Aman, Andrew S Bernhardson, Luke O'Brien, Robert F LaPrade

Abstract

Blood flow restriction (BFR) training involves occluding venous outflow while maintaining arterial inflow by the application of an extremity tourniquet after surgery. BFR ultimately reduces oxygen delivery to muscle cells, similar to an anaerobic environment, and allows patients to exercise with low resistance and stimulates muscle hypertrophy and strength using heavy resistance. Thus orthopaedic surgeons and physical therapists are incorporating this type of training into their postoperative rehabilitation protocols, particularly after injuries or surgical procedures about the knee joint. The purpose of this Technical Note is to describe a BFR clinical application technique and to report on the indications, safety considerations, and postoperative knee surgery rehabilitation protocols for BFR.

Figures

Fig 1
Fig 1
Blood flow restriction (BFR) therapy application. (A) Delfi Personalized Tourniquet System for BFR with pneumatic cuff (third-generation tourniquet). (B) Application of BFR during quadriceps activation exercise after arthroscopic knee surgery.
Fig 2
Fig 2
The components of blood flow restriction (BFR) consist of a personalized tourniquet system (A), which tailors the personalized tourniquet pressure to each patient after determination of the limb occlusion pressure, and a contoured tourniquet cuff (B), which is available in 3 different lengths (length use is dependent on patient thigh size). These components are then connected by a hose assembly. ∗ indicates the contoured strap of the personalized tourniquet.
Fig 3
Fig 3
The immediate postoperative condition of non–weight-bearing protocols should be maintained while using blood flow restriction (BFR), having the patient engage in low-load activities (A) strictly consisting of muscle contractions. Patients may later progress to body-weight closed kinetic chain exercises (B) when advanced to weight-bearing protocols and further to low-resistance exercises (C) once postoperative restrictions are reduced.

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