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.(2019)

PICO

Patient/Population

unilateral ACLR surgery (n=28)

Intervention

  • Blood flow restriction resistance training (BFR-RT)

Comparison

  • Traditional heavy-load resistance training (HL-RT)

Outcomes

  • Muscle hypertrophy

  • Strength

  • Physical function

  • Knee pain

  • Eeffusion

Translatability:   (3/3) Easy                                    

Comments: BFR-RT results in similar improvements in strength and muscle size as HL-RT following ACLR surgery and rehabilitation. In comparison to HL-RT, BFR-RT resulted in greater and clinically important improvements in all measures of self-reported function and Y-balance performance following ACLR surgery and rehabilitation. BFR-RT had a greater reduction in knee joint pain, swelling and range of movement following ACLR rehabilitation.
Limitations: Muscle hypertrophy measured in single plane only. Other factors like tendon stiffness, ligament condition not considered. Warm-up weight standardization could have been improved. Participants not blinded to intervention group allocation due to ethical reasons. Study focused on specific ACLR patient subgroup. Limited generalization to other graft types, ages. Article concentrated on a specific phase of ACLR rehabilitation. Small sample size may limit result generalizability to broader populations

Appraisals:

Cochrane risk-of-bias – (4/5) Blinding of participants and personnel: No (by:  Colombo, V., Valenčič, T., Steiner, K., Škarabot, J., Folland, J., O’Sullivan, O., & Kluzek, S. (2024). Comparison of Blood Flow Restriction Interventions to Standard Rehabilitation After an Anterior Cruciate Ligament Injury: A Systematic Review. The American journal of sports medicine, 3635465241232002. Advance online publication. https://doi.org/10.1177/03635465241232002)

Trustworthiness – The study contains no serious weaknesses. Based on this result you should conclude that the trustworthiness of the study is high (90%). This means there is a 10% chance that alternative explanations for the effect found are possible. The effect size was large and 95% CI was OK. (by CAT)

Metrics and
Journal Details:

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BTB

Intervention

  • Blood flow restriction resistance training

Dose

  • 5 min light cycle

  • 10 reps of unilateral leg press at light weight

  • 4 sets (30, 15, 15, 15 reps, 30 s interset rest) of unilateral leg press at 30% of predicted 1RM with BFR at 80% Limb Occlusion Pressure

Periodicity

  • 2 X p/week for 8 weeks

Local/Technic:

  • Initiated 2 weeks after surgery upon surgeon approval and suture removal, if:
    • Ability to bear weight unilaterally without pain for ≥ 5 seconds without support
    • Demonstration of knee range of motion (ROM) of 0–90° using a goniometer
    • Performance of repeated straight leg raises without knee extensor (KE) muscle lag, activation of gluteal and knee flexor (KF) muscles, and minimal effusion change with activity

    Comparison

    • Traditional heavy-load resistance training

    Dose

    • 5 min light cycle

      O reps of unilateral leg press at light weight

      3 x 10 reps (30 s interset rest) of unilateral leg press at 70% of predicted 1RM

    Periodicity

    • 2 X p/week for 8 weeks

    Local/Technic:

    • Initiated 2 weeks after surgery upon surgeon approval and suture removal, if:
      • Ability to bear weight unilaterally without pain for ≥ 5 seconds without support
      • Demonstration of knee range of motion (ROM) of 0–90° using a goniometer
      • Performance of repeated straight leg raises without knee extensor (KE) muscle lag, activation of gluteal and knee flexor (KF) muscles, and minimal effusion change with activity

    Citation: Hughes, L., Rosenblatt, B., Haddad, F., Gissane, C., McCarthy, D., Clarke, T., Ferris, G., Dawes, J., Paton, B., & Patterson, S. D. (2019). 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 medicine (Auckland, N.Z.),49(11), 1787–1805. https://doi.org/10.1007/s40279-019-01137-2

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