Perioperative Blood Flow Restriction Rehabilitation in Patients Undergoing ACL Reconstruction: A Systematic Review

Yining Lu, Bhavik H Patel, Craig Kym, Benedict U Nwachukwu, Alexander Beletksy, Brian Forsythe, Jorge Chahla, Yining Lu, Bhavik H Patel, Craig Kym, Benedict U Nwachukwu, Alexander Beletksy, Brian Forsythe, Jorge Chahla

Abstract

Background: Low-load blood flow restriction (BFR) training has attracted attention as a potentially effective method of perioperative clinical rehabilitation for patients undergoing orthopaedic procedures.

Purpose: To (1) compare the effectiveness of low-load BFR training in conjunction with a standard rehabilitation protocol, pre- and postoperatively, and non-BFR interventions in patients undergoing anterior cruciate ligament reconstruction (ACLR) and (2) evaluate protocols for implementing BFR perioperatively for patients undergoing ACLR.

Study design: Systematic review; Level of evidence, 2.

Methods: A systematic review of the 3 medical literature databases was conducted to identify all level 1 and 2 clinical trials published since 1990 on BFR in patients undergoing ACLR. Patient demographics from included studies were pooled. Outcome data were documented, including muscle strength and size, and perceived pain and exertion. A descriptive analysis of outcomes from BFR and non-BFR interventions was performed.

Results: A total of 6 studies (154 patients; 66.2% male; mean ± SD age, 24.2 ± 3.68 years) were included. Of these, 2 studies examined low-load BFR as a preoperative intervention, 1 of which observed a significant increase in muscle isometric endurance (P = .014), surface electromyography of the vastus medialis (P < .001), and muscle blood flow to the vastus lateralis at final follow-up (P < .001) as compared with patients undergoing sham BFR. Four studies investigated low-load BFR as a postoperative intervention, and they observed significant benefits in muscle hypertrophy, as measured by cross-sectional area; strength, as measured by extensor torque; and subjective outcomes, as measured by subjective knee pain during session, over traditional low-load resistance training (all P < .05). BFR occlusion periods ranged from 3 to 5 minutes, with rest periods ranging from 45 seconds to 3 minutes.

Conclusion: This systematic review found evidence on the topic of BFR rehabilitation after ACLR to be sparse and heterogeneous likely because of the relatively recent onset of its popularity. While a few authors have demonstrated the potential strength and hypertrophy benefits of perioperative BFR, future investigations with standardized outcomes, long-term follow-up, and more robust sample sizes are required to draw more definitive conclusions.

Keywords: KAATSU; anterior cruciate ligament reconstruction; blood flow restriction; clinical rehabilitation.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.U.N. has received educational support from Smith & Nephew and hospitality payments from Stryker, Wright Medical, and Zimmer Biomet. B.F. has received research support from Arthrex, Smith & Nephew, and Stryker; educational support from Medwest; consulting fees from Sonoma Orthopedics and Stryker; honoraria from Arthrosurface; and royalties from Elsevier and has stock/stock options in Jace Medical. J.C. has received educational support from Arthrex and Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2020.

Figures

Figure 1.
Figure 1.
Flowchart of study selection process.

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