Blood Flow Restriction as Adjunct During ACL Reconstruction Rehab

Key Takeaways

• Blood flow restriction added during postoperative weeks 13 to 20 was associated with higher week-24 IKDC and Tegner scores than sham.
• The active group also showed greater isometric knee extensor and flexor strength, better Y-Balance performance, and higher quadriceps sEMG amplitudes at follow-up.
• No between-group difference was reported for knee range of motion or quadriceps muscle thickness, and baseline and immediate post-intervention assessments were not available.

At postoperative week 24, a randomized sham-controlled trial of 48 adults after primary unilateral ACL reconstruction showed higher IKDC and Tegner scores with adjunctive blood flow restriction than sham. Among 43 completers, the active intervention was added during weeks 13 to 20 of rehabilitation rather than used instead of exercise. Multiple outcomes were assessed at follow-up, and immediate post-training change data were not reported. Between-group differences were assessed at week 24.

The single-center randomized controlled study enrolled patients aged 18 to 35 years undergoing primary unilateral ACL reconstruction. From postoperative weeks 13 to 20, both groups performed identical low-load resistance training at 30% one-repetition maximum twice weekly. The active arm received individualized cuff pressure set at 40% arterial occlusion pressure, while the comparator group received minimal cuff pressure.

Outcomes were assessed at postoperative week 24 and included IKDC, Tegner Activity Scale, knee range of motion, isometric strength, quadriceps muscle thickness, Y-Balance performance, and quadriceps sEMG. The comparator was sham-BFR rather than usual care alone, so the design evaluated the adjunct within a matched exercise program and cuff setup.

Forty-three patients completed the study, with 21 assigned to the blood flow restriction group and 22 to sham-BFR at the final assessment. At week 24, IKDC and Tegner scores were higher in the active group, with p values below 0.01 across both patient-reported measures. Isometric knee extensor and flexor strength, Y-Balance composite scores, and quadriceps sEMG amplitudes were also greater, each meeting p<0.05 at the same follow-up. These differences were observed at postoperative follow-up rather than immediately after the weeks 13 to 20 training phase. The findings at 24 weeks favored the active group across functional, strength, balance, and neuromuscular measures.

No significant between-group differences were reported for knee range of motion or quadriceps muscle thickness at postoperative week 24. Baseline outcome measurements and immediate post-intervention assessments were not available, which limits interpretation of change over time in the reported data. The week-24 comparisons therefore reflect between-group findings within the reported follow-up window.