Paper 21: Blood Flow Restriction Therapy Improves Early Patient Reported Outcomes Following ACL Reconstruction

Abstract

Objectives:To evaluate the affect of blood flow restriction (BFR) therapy conducted both before and after anterior cruciate ligament (ACL) reconstruction on early quadriceps strength and patient reported outcomes.Methods:A total of 43 patients (24 male, 19 female; age 27.6 ± 11.88 years) presenting with an ACL tear were randomized into two groups, BFR (N=22) and Control (N=21) at their initial clinic visit (ICV). 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 ICV. All patients were provided education on preoperative exercises to be performed 4-5 days per week for two weeks between the ICV 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. Following surgery, patients underwent physical therapy utilizing standard post-ACL reconstruction therapy protocols, with exercises performed with and without the use of BFR in each respective group. Patient Reported Outcome Measurement System Physical Function (PROMIS-PF), International Knee Documentation Committee (IKDC) scores, knee range of motion and quadriceps circumference were gathered at the ICV, the day of surgery, 2 weeks and 6 weeks after surgery. Quadriceps strength measurements were repeated the day of surgery and six weeks following ACL reconstruction.Results:No significant differences were noted between the BFR and control groups in peak quadriceps force generation (Figure 1), time to peak force or average force at any timepoints (P>0.05). At six weeks post-surgery, the BFR group had significantly higher PROMIS-PF (43.16 ± 5.29 versus 38.39 ± 5.39, p=0.02) and IKDC (58.22 ± 7.64 versus 47.05 ± 13.50, p=0.01, Figure 2) scores compared to the control group.Conclusions:Blood flow restriction therapy before and after ACL reconstruction results in improved patient reported outcomes scores without objective improvements in strength at six week follow up. Long term follow up is needed to determine if differences arise in quadriceps strength between groups.Figure 1.Peak quadriceps force of the injured leg measured in Newtons during the initial clinic visit (ICV), day of surgery (PreOp) and 6 weeks post ACL reconstructions. No statistically significant differences (p>0.05) Figure 2.International Knee Documentation Committee (IKDC) scores collected at initial clinicvisit (ICV), day of surgery (PreOp), 2 weeks and 6 weeks following ACL reconstruction. * Denotes statistically significant difference between groups (p<0.05)