The Effect of Blood Flow Restriction Training on Muscle Atrophy Following Meniscal Repair or Chondral Restoration Surgery in Active Duty Military: A Randomized Controlled Trial

in Journal of Sport Rehabilitation

Click name to view affiliation

John S. Mason
Search for other papers by John S. Mason in
Current site
Google Scholar
PubMed
Close
,
Michael S. Crowell
Search for other papers by Michael S. Crowell in
Current site
Google Scholar
PubMed
Close
,
Richard A. Brindle
Search for other papers by Richard A. Brindle in
Current site
Google Scholar
PubMed
Close
,
Jeffery A. Dolbeer
Search for other papers by Jeffery A. Dolbeer in
Current site
Google Scholar
PubMed
Close
,
Erin M. Miller
Search for other papers by Erin M. Miller in
Current site
Google Scholar
PubMed
Close
,
Todd A. Telemeco
Search for other papers by Todd A. Telemeco in
Current site
Google Scholar
PubMed
Close
, and
Donald L. Goss
Search for other papers by Donald L. Goss in
Current site
Google Scholar
PubMed
Close
Restricted access

Context: Recently, blood flow restriction (BFR) training has gained popularity as an alternative to high-load resistance training for improving muscle strength and hypertrophy. Previous BFR studies have reported positive treatment effects; however, clinical benefits to using BFR following meniscal repair or chondral surgery are unknown. The purpose of this study was to determine the effect of resistance exercises with BFR training versus exercises alone on self-reported knee function, thigh circumference, and knee flexor/extensor strength postmeniscal or cartilage surgery. Design: Single-blinded randomized controlled trial in an outpatient military hospital setting. Twenty participants were randomized into 2 groups: BFR group (n = 11) and control group (n = 9). Methods: Participants completed 12 weeks of postoperative thigh strengthening. The BFR group performed each exercise with the addition of BFR. Both groups continued with the prescribed exercises without BFR from 12 weeks until discharged from therapy. Thigh circumference and self-reported knee function were measured at 1, 6, 12, and 24 weeks postoperatively along with knee extensor and flexor strength at 12 and 24 weeks. Change scores between time points were calculated for knee function. Limb symmetry indices (LSI) were computed for thigh circumference and knee strength variables. Results: Seventeen participants were included in the final analyses (BFR = 8 and control = 9) due to COVID-19 restrictions. There were no interactions or main effects for group. Time main effects were established for change in knee function scores, thigh circumference LSI, and knee extensor strength LSI. However, knee flexor strength LSI had no main effect for time. Conclusion: The outcomes of this trial suggest that resistance exercises with and without BFR training may result in similar changes to function, thigh atrophy, and knee extensor strength postmeniscus repair/chondral restoration, though further study with larger sample sizes is needed.

Mason, Crowell, Brindle, Miller, and Goss are with the Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, Baylor University, West Point, NY, USA. Dolbeer is with the United States Army Special Operations Command, Fort Bragg, NC, USA. Telemeco is with the University of North Carolina at Pembroke, Pembroke, NC, USA. Goss is also with High Point University, High Point, NC, USA.

Mason (johnsmason31@gmail.com) is corresponding author.
  • Collapse
  • Expand
  • 1.

    Nielsen AB, Yde J. Epidemiology of acute knee injuries: a prospective hospital investigation. J Trauma. 1991;31(12):16441648. PubMed ID: 1749037 doi:10.1097/00005373-199112000-00014

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

    Baker BE, Peckham AC, Pupparo F, Sanborn JC. Review of meniscal injury and associated sports. Am J Sports Med. 1985;13(1):14. PubMed ID: 3838420 doi:10.1177/036354658501300101

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

    Cook JL. The current status of treatment for large meniscal defects. Clin Orthop. 2005;435:8895. doi:10.1097/00003086-200506000-00014

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

    Jones JC, Burks R, Owens BD, Sturdivant RX, Svoboda SJ, Cameron KL. Incidence and risk factors associated with meniscal injuries among active-duty US military service members. J Athl Train. 2012;47(1):6773. PubMed ID: 22488232 doi:10.4085/1062-6050-47.1.67

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

    Hughes L, Rosenblatt B, Haddad F, et al. Comparing the effectiveness of blood flow restriction and traditional heavy load resistance training in the post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: a UK National Health Service Randomised Controlled Trial. Sports Med. 2019;49(11):17871805. PubMed ID: 31301034 doi:10.1007/s40279-019-01137-2

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

    Akima H, Furukawa T . Atrophy of thigh muscles after meniscal lesions and arthroscopic partial menisectomy. Knee Surg Sports Traumatol Arthrosc. 2005;13(8):632637. PubMed ID: 15827765 doi:10.1007/s00167-004-0602-9

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

    Cruz-Martinez A, Ramirez A, Arpa J. Quadriceps atrophy after knee traumatisms and immobilization: electrophysiological assessment. Eur Neurol. 2000;43(2):110114. PubMed ID: 10686470 doi:10.1159/000008145

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

    Slemenda C, Brandt KD, Heilman DK, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med. 1997;127(2):97104. PubMed ID: 9230035 doi:10.7326/0003-4819-127-2-199707150-00001

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

    American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687708. doi:10.1249/MSS.0b013e3181915670

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

    Jessee MB, Mattocks KT, Buckner SL, et al. Mechanisms of blood flow restriction: the new testament. Tech Orthop. 2018;33(2):7279. doi:10.1097/BTO.0000000000000252

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

    Ilett MJ, Rantalainen T, Keske MA, May AK, Warmington SA. The effects of restriction pressures on the acute responses to blood flow restriction exercise. Front Physiol. 2019;10:1018. doi:10.3389/fphys.2019.01018

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

    Patterson SD, Hughes L, Warmington S, et al. Blood flow restriction exercise: considerations of methodology, application, and safety. Front Physiol. 2019;10:533. doi:10.3389/fphys.2019.00533

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

    Kubota A, Sakuraba K, Sawaki K, Sumide T, Tamura Y . Prevention of disuse muscular weakness by restriction of blood flow. Med Sci Sports Exerc. 2008;40(3):529534. PubMed ID: 18379217 doi:10.1249/MSS.0b013e31815ddac6

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

    Cook SB, Brown KA, Deruisseau K, Kanaley JA, Ploutz-Snyder LL. Skeletal muscle adaptations following blood flow-restricted training during 30 days of muscular unloading. J Appl Physiol. 2010;109(2):341349. doi:10.1152/japplphysiol.01288.2009

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

    Kubota A, Sakuraba K, Koh S, Ogura Y, Tamura Y. Blood flow restriction by low compressive force prevents disuse muscular weakness. J Sci Med Sport Sports Med Aust. 2011;14(2):9599. doi:10.1016/j.jsams.2010.08.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Slysz J, Stultz J, Burr JF. The efficacy of blood flow restricted exercise: a systematic review & meta-analysis. J Sci Med Sport. 2016;19(8):669675. PubMed ID: 26463594 doi:10.1016/j.jsams.2015.09.005

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

    Lixandrão ME, Ugrinowitsch C, Berton R, et al. Magnitude of muscle strength and mass adaptations between high-load resistance training versus low-load resistance training associated with blood-flow restriction: a systematic review and meta-analysis. Sports Med. 2018;48(2):361378. PubMed ID: 29043659 doi:10.1007/s40279-017-0795-y

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

    Loenneke JP, Wilson JM, Marin PJ, Zourdos MC, Bemben MG . Low intensity blood flow restriction training: a meta-analysis. Eur J Appl Physiol. 2012;112(5):18491859. PubMed ID: 21922259 doi:10.1007/s00421-011-2167-x

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

    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
  • 20.

    Yasuda T, Loenneke JP, Ogasawara R, Abe T. Influence of continuous or intermittent blood flow restriction on muscle activation during low-intensity multiple sets of resistance exercise. Acta Physiol Hung. 2013;100(4):419426. PubMed ID: 24317348 doi:10.1556/APhysiol.100.2013.4.6

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

    Takarada Y, Nakamura Y, Aruga S, Onda T, Miyazaki S, Ishii N. Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol. 2000;88(1):6165. PubMed ID: 10642363 doi:10.1152/jappl.2000.88.1.61

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Pierce JR, Clark BC, Ploutz-Snyder LL, Kanaley JA. Growth hormone and muscle function responses to skeletal muscle ischemia. J Appl Physiol. 2006;101(6):15881595. doi:10.1152/japplphysiol.00585.2006

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

    Takano H, Morita T, Iida H, et al. Hemodynamic and hormonal responses to a short-term low-intensity resistance exercise with the reduction of muscle blood flow. Eur J Appl Physiol. 2005;95(1):6573. PubMed ID: 15959798 doi:10.1007/s00421-005-1389-1

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

    Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175191. PubMed ID: 17695343 doi:10.3758/BF03193146

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

    Joshi S, Mahoney S, Jahan J, Pitts L, Hackney KJ, Jarajapu YP. Blood flow restriction exercise stimulates mobilization of hematopoietic stem/progenitor cells and increases the circulating ACE2 levels in healthy adults. J Appl Physiol. 2020;128(5):14231431. PubMed ID: 32324479 doi:10.1152/japplphysiol.00109.2020

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

    Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. Phys Ther. 1999;79(4):371383. PubMed ID: 10201543

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

    Soderberg GL, Ballantyne BT, Kestel LL. Reliability of lower extremity girth measurements after anterior cruciate ligament reconstruction. Physiother Res Int J Res Clin Phys Ther. 1996;1(1):716. doi:10.1002/pri.43

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Lepley LK . Deficits in quadriceps strength and patient-oriented outcomes at return to activity after ACL reconstruction: a review of the current literature. Sports Health. 2015;7(3):231238. PubMed ID: 26131300 doi:10.1177/1941738115578112

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Krych A, Arutyunyan G, Kuzma S, Levy B, Dahm D, Stuart M. Adverse effect of femoral nerve blockade on quadriceps strength and function after ACL reconstruction. J Knee Surg. 2015;28(1):8388. PubMed ID: 24622910 doi:10.1055/s-0034-1371769

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Lee S, Seong SC, Jo H, Park YK, Lee MC. Outcome of anterior cruciate ligament reconstruction using quadriceps tendon autograft. Arthrosc J Arthrosc Relat Surg. 2004;20(8):795802. doi:10.1016/S0749-8063(04)00594-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Cohen J. A power primer. Psychological Bulletin. 1992;112(1):155159.

  • 32.

    Bryk FF, Dos Reis AC, Fingerhut D, et al. Exercises with partial vascular occlusion in patients with knee osteoarthritis: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2016;24(5):15801586. doi:10.1007/s00167-016-4064-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Ross CM, Worrell TW. Thigh and calf girth following knee injury and surgery. J Orthop Sports Phys Ther. 1998;27(1):915. PubMed ID: 9440035 doi:10.2519/jospt.1998.27.1.9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C, Sowers MF. Isometric quadriceps strength in women with mild, moderate, and severe knee osteoarthritis. Am J Phys Med Rehabil Assoc Acad Physiatr. 2010;89(7):541548. doi:10.1097/PHM.0b013e3181ddd5c3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Parry Gerber J, Marcus RL, Dibble LE, LaStayo PC . The use of eccentrically biased resistance exercise to mitigate muscle impairments following anterior cruciate ligament reconstruction: A short review. 2009. https://journals.sagepub.com/doi/full/10.1177/1941738108327531?casa_token=fcSaWRjZDHUAAAAA%3AJ1Cb3tR3bH4N1iIrfp4QJCKDOIsdar8S_i9b_yxK1nfEpR26O-ba0n2YE-mXAj7d_J7HMn7kwD5shw. Accessed October 20, 2020.

    • Search Google Scholar
    • Export Citation
  • 36.

    Ozaki H, Miyachi M, Nakajima T, Abe T. Effects of 10 weeks walk training with leg blood flow reduction on carotid arterial compliance and muscle size in the elderly adults. Angiology. 2011;62(1):8186. PubMed ID: 20682613 doi:10.1177/0003319710375942

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    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
  • 38.

    Lisee C, Lepley AS, Birchmeier T, O’Hagan K, Kuenze C. Quadriceps strength and volitional activation after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Sports Health. 2019;11(2):163179. PubMed ID: 30638441 doi:10.1177/1941738118822739

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Abe T, Loenneke JP, Fahs CA, Rossow LM, Thiebaud RS, Bemben MG . Exercise intensity and muscle hypertrophy in blood flow-restricted limbs and non-restricted muscles: a brief review. Clin Physiol Funct Imaging. 2012;32(4):247252. PubMed ID: 22681600 doi:10.1111/j.1475-097X.2012.01126.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Iversen E, Røstad V, Larmo A . Intermittent blood flow restriction does not reduce atrophy following anterior cruciate ligament reconstruction. J Sport Health Sci. 2016;5(1):115118. PubMed ID: 30356481 doi:10.1016/j.jshs.2014.12.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

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

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 7154 3218 220
Full Text Views 641 85 2
PDF Downloads 480 111 4