Libby Lueck - Department of Orthopedic Surgery
One of the primary postoperative concerns of anterior cruciate ligament (ACL) reconstructions is muscle atrophy and decreased bone mineral density. The resulting knee deficiencies and strength imbalance result in a higher likelihood of reinjury and/or unsuccessful return to sport. Blood flow restriction (BFR) therapy is a new method of recovery being used in combination with resistance training to speed up recovery. BFR works by restricting vascular flow in the injured limb by applying a cuff and pumping it up, either manually or via machine, to the desired pressure. Once the cuff is pumped up the patient must not go past 20 minutes without relieving the pressure, giving the limb a break. Jack II et al. performed a randomized controlled clinical trial to determine the effects of BFR post-ACL surgery. In the study, they followed two groups of patients - one using BFR, the other not (control group) - for 12 weeks of postoperative physical therapy and then a follow-up 2 years later. The results were astonishing: only the control group experienced a decrease in bone mineral density (BMD), while the BFR group preserved complete BMD. Furthermore, only the control group experienced decreases in muscle mass compared to presurgery. Overall, the BFR group had a quicker return to sport time than the control group. It is important to note, however, that one of the limitations of this study was such a short follow-up time. Longer follow-up timelines could yield different results, not to mention that it is unclear how many of the patients in the study had follow-ups.
BFR is currently being used by physical therapists nationwide. This is a huge leap in the field of surgical recovery as the biggest beast in recovery for many sports injuries is making up for that deficit of muscle atrophy that has developed from immobilization. BFR is not restricted to ACL recovery either as it can be used on other lower limb and upper limb injuries. In fact, BFR has been shown to have positive effects not only on the targeted limb muscles but also on muscles proximal to the cuff placement. For example, in upper limb occlusion, shoulder and back muscles have shown an increase in size and strength along with targeted arm muscles distal to the cuff. Expanding beyond orthopedic surgery, BFR could potentially be more mainstream, reaching a variety of patient populations. In new studies researched by Vinolo-Gil et al. BFR has been shown to improve quality of life, physical strength, function, and lean mass in postoperative cancer patients. Blood flow restriction therapy could open the door to improved satisfaction, comfort, and recovery in limitless patient populations.
References:
Jack, R. A., 2nd, Lambert, B. S., Hedt, C. A., Delgado, D., Goble, H., & McCulloch, P. C. (2023). Blood Flow Restriction Therapy Preserves Lower Extremity Bone and Muscle Mass After ACL Reconstruction. Sports health, 15(3), 361–371. https://doi.org/10.1177/19417381221101006
Vinolo-Gil MJ, García-Campanario I, Estebanez-Pérez M-J, Pastora-Bernal J-M, Rodríguez-Huguet M, Martín-Vega FJ. Blood Flow Restriction in Oncological Patients: Advantages and Safety Considerations. Healthcare. 2023; 11(14):2062. https://doi.org/10.3390/healthcare11142062
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