Does Blood Flow Restriction Training Improve Quadriceps Measures After Arthroscopic Knee Surgery? A Critically Appraised Topic

in International Journal of Athletic Therapy and Training
Erik H. Arve PT, DPT, CSCS, * , 1 , Emily Madrak  MS, LAT, ATC, * , 1 and Aric J. Warren  PhD, LAT, ATC, CES * , 1
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  • 1 Oklahoma State University Center for Health Sciences
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Focused Clinical Question: Is there evidence to suggest that blood flow restriction (BFR) training improves strength, cross-sectional area, and thigh girth of the quadriceps musculature in patients after arthroscopic surgical procedures of the knee? Clinical Bottom Line: There is moderate consistent, but low-level, evidence supporting the use of BFR training to improve knee extensor muscular outcomes (strength, cross-sectional area, and/or thigh girth) immediately after arthroscopic knee surgery.

The authors are with Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.

Warren (aric.warren@okstate.edu) is corresponding author.
  • 1.

    Herzog MM, Marshall SW, Lund JL, Pate V, et al. Trends in incidence of ACL reconstruction and concomitant procedures among commercially insured individuals in the United States, 2002–2014. Sports Health. 2018;10(6):523531. PubMed ID: 30355175 doi:10.1177/1941738118803616

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Rosenberg TD, Franklin JL, Baldwin GN, Nelson KA. Extensor mechanism function after patellar tendon graft harvest for anterior cruciate ligament reconstruction. Am J Sports Med. 1992;20(5):519526. PubMed ID: 1443318 doi:10.1177/036354659202000506

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Ithurburn MP, Paterno MV, Ford KR, Hewett TE, Schmitt LC. Young athletes after anterior cruciate ligament reconstruction with single-leg landing asymmetries at the time of return to sport demonstrate decreased knee function 2 years later. Am J Sports Med. 2017;45(11):26042613. PubMed ID: 28644677 doi:10.1177/0363546517708996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Ithurburn MP, Paterno MV, Ford KR, Hewett TE, Schmitt LC. Young athletes with quadriceps femoris strength asymmetry at return to sport after anterior cruciate ligament reconstruction demonstrate asymmetric single-leg drop-landing mechanics. Am J Sports Med. 2015;43(11):27272737. PubMed ID: 26359376 doi:10.1177/0363546515602016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Palmieri-Smith RM, Lepley LK. Quadriceps strength asymmetry following ACL reconstruction alters knee joint biomechanics and functional performance at time of return to activity. Am J Sports Med. 2015; 43(7):16621669. PubMed ID: 25883169 doi:10.1177/0363546515578252

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Schmitt LC, Paterno MV, Ford KR, Myer GD, Hewett TE. Strength asymmetry and landing mechanics at return to sport after anterior cruciate ligament reconstruction. Med Sci Sports Exerc. 2015;47(7):14261434. PubMed ID: 25373481 doi:10.1249/MSS.0000000000000560

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Schmitt LC, Paterno MV, Hewett TE. The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2012;42(9):750759. PubMed ID: 22813542 doi:10.2519/jospt.2012.4194

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Zwolski C, Schmitt LC, Quatman-Yates C, Thomas S, Hewett TE, Paterno MV. The influence of quadriceps strength asymmetry on patient-reported function at time of return to sport after anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43(9):22422249. PubMed ID: 26183172 doi:10.1177/0363546515591258

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    McLeod MM, Gribble P, Pfile KR, Pietrosimone BG. Effects of arthroscopic partial meniscectomy on quadriceps strength: A systematic review. J Sport Rehabil. 2012;21(3):285295. PubMed ID: 22234935 doi:10.1123/jsr.21.3.285

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Fahrer H, Rentsch HU, Gerber NJ, Beyeler C, Hess CW, Grung B. Knee effusion and reflex inhibition of quadriceps. A bar to effective retraining. J Bone Joint Surg. 1988;70(4):635638. doi:10.1302/0301-620X.70B4.3403614

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Suter E, Herzog W, Bray RC. Quadriceps inhibition following arthroscopy in patients with anterior knee pain. Clin Biomech. 1997;13(1998):314319.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Rice DA, McNair PJ, Lewis GN, Dalbeth N. The Effect of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps strength, and pain in individuals with knee synovitis: A prospective observational study. Arthritis Res Ther. 2015;17:191. PubMed ID: 26215105 doi:10.1186/s13075-015-0711-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Mason JS, Owens JG, Brown WJ. Blood flow restriction training: Current and future applications for the rehabilitation of musculoskeletal injuries. Tech Orthop. 2018;33(2):71. doi:10.1097/BTO.0000000000000301

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Scott BR, Ooenneke JP, Slattery KM, Dascombe BJ. Blood flow restricted exercise for athletes: A review of available evidence. J Sci Med Sport. 2016;19:360367. PubMed ID: 26118847 doi:10.1016/j.jsams.2015.04.014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Binnie MJ. Blood flow restriction techniques for exercise performance: A review of current research and practical applications. J Aust Strength Cond. 2017;25(3): 6270.

    • Search Google Scholar
    • Export Citation
  • 16.

    Ohta H, Kurosawa H, Ikeda H, Iwase Y, Satou N, Nakamura S. Low-load resistance muscular training with moderate restriction of blood flow after anterior cruciate ligament reconstruction. Acta Orthop Scand. 2003;74(1):6268. PubMed ID: 12635796 doi:10.1080/00016470310013680

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Takarada Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc. 2000;32(12):20352039. PubMed ID: 11128848 doi:10.1097/00005768-200012000-00011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Tennent DJ, Hylden CM, Johnson AE, Burns TC, Wilken JM, Owens JG. Blood flow restriction training after knee arthroscopy: A randomized controlled pilot study. Clin J Sport Med. 2017;27(3):245252. PubMed ID: 27749358 doi:10.1097/JSM.0000000000000377

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Iversen E, Rostad V, Arne L. Intermittent blood flow restriction does not reduce atrophy following anterior cruciate ligament reconstruction. J of Sport and Health Sci. 2015; 5(2016):115118.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Tennent DJ, Burns T, Johnson AE, Owens J. Blood flow restriction training for postoperative lower-extremity weakness: A report of three cases. Curr Sports Med Rep. 2018. 17(4):119122. PubMed ID: 29629970 doi:10.1249/JSR.0000000000000470

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Lafont MA, Elokda A, Jeffreys-Heil R. Blood flow restriction training in the post-operative management of a female soccer player with an anterior cruciate ligament reconstruction and left lateral meniscus repair: A case report [doctoral thesis]. Fort Meyers, FL: Florida Gulf Coast University; 2018.

    • Search Google Scholar
    • Export Citation
  • 22.

    Hart JM, Pietrosimone B, Hertel J, Ingersoll CD. Quadriceps activation following knee injuries: a systematic review. J Athl Train. 2010;45:8797. PubMed ID: 20064053 doi:10.4085/1062-6050-45.1.87

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41:58292. PubMed ID: 12719681

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Ross M, Worrell TW. Thigh and calf girth following knee injury and surgery. J Orthop Sports Phys Ther. 1998;27:915. PubMed ID: 9440035 doi:10.2519/jospt.1998.27.1.9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Reilly CW, McEwan JA, Leveille L, Perdios A, Mulpuri K. Minimizing tourniquet pressure in pediatric anterior cruciate ligament reconstructive surgery: a blinded, prospective randomized controlled trial. J Pediatr Orthop. 2009;29:275280. PubMed ID: 19305279 doi:10.1097/BPO.0b013e31819bcd14

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Younger AS, McEwen JA, Inkpen K. Wide contoured thigh cuffs and automated limb occlusion measurement allow lower tourniquet pressures. Clin Orthop Relat Res. 2004;428:286293. doi:10.1097/01.blo.0000142625.82654.b3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Loenneke JP, Fahs CA, Rossow LM, et al. Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise. Eur J Appl Physiol. 2012;112:29032912. PubMed ID: 22143843 doi:10.1007/s00421-011-2266-8

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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