Blood flow restriction therapy to restore quadriceps wasting persistent after anterior cruciate ligament reconstruction

INTRODUCTION: Anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee that requires surgical intervention. After ACL reconstruction, it has been reported that quadriceps wasting can persist for years even after complete rehabilitation and aggressive physiotherapy. Blood flow restriction (BFR) therapy is proposed to induce muscle growth and improve strength in chronic muscle atrophy. But the data on the efficacy of BFR therapy are controversial and lacking in the existing literature. AIMS/OBJECTIVES: In this study, we focus on identifying the patients having chronic quadriceps wasting after ACL reconstruction and intervene to restore the quadriceps wasting using BFR therapy. MATERIALS AND METHODS: All the participants had unilateral reconstruction of ACL tear >1 year back and completed the standard postoperative rehabilitation protocol but had >10% of difference in quadriceps thickness in the involved limb as compared to contra-lateral limb measured by ultrasonography. They were then proceeded further with BFR therapy and were re-examined after 6 weeks of BFR therapy. RESULTS: It was observed that 64% of the participants had persistent quadriceps muscle atrophy even after 1 year of completing standard post-rehabilitation protocol after ACL reconstruction with more than 10% deficit. The quadriceps thickness observed after the BFR therapy increased by 10 ± 7% at one-third of femur length from knee joint and 16.6 ± 4% at two-thirds of femur length in the involved extremity but did not show any change in uninvolved extremity. Post-training quadriceps femoris symmetry index also increased in the involved extremity compared to the baseline (87 ± 5% pre-procedure to 96 ± 4% post-procedure, P <0.01). CONCLUSION: This study concludes that BFR therapy after knee surgery may be a viable modality for the treatment of residual atrophy of quadriceps after years of ACLR. This can be used in patients who require extra assistance in resisting muscle atrophy or building muscle strength.