Background Blood flow restriction training (BFRT) has gained popularity in rehabilitation due to its benefits in reducing muscle atrophy and mitigating strength deficits following anterior cruciate ligament reconstruction (ACLR). While the effectiveness and safety of BFRT has been well studied in healthy adult subjects, there is limited information about the use of BFRT in the adolescent population, specifically related to patient tolerance and reported side effects post ACLR. Purpose To investigate and record reported side effects and patient tolerance to BFRT during ACLR rehabilitation in adolescents. Study Design Prospective Cohort Study Methods Patients between 12 and 18 years of age who underwent ACLR at Connecticut Children’s were included. Patients utilized an automatic personalized tourniquet system and followed a standardized BFRT exercise protocol over 12 weeks starting 8.72 ± 3.32 days post-op. Upon completion of exercise while using BFRT, patients reported side effects and any adverse events were logged. Descriptive statistics were used to describe the reported side effects and adverse events associated with BFRT and calculate the frequencies of those events over a 12-week period. Results Five hundred and thirty-five total BFRT sessions were completed between 29 patients (15.39 ± 1.61 years of age). There were zero reports of subcutaneous hemorrhage (SubQ hemorrhage) and deep vein thrombosis (DVT). Reported minor side effects to BFRT included itchiness of the occluded limb (7.85%), lower extremity paresthesia (2.81%), and dizziness (0.75%). A total of 10.47% of BFR treatment sessions were unable to be completed due to tolerance, and 3.5% of sessions required a reduction in limb occlusion pressure (LOP). Conclusion These preliminary data suggest that BFRT is safe with only minor side effects noted in the adolescent population after ACLR. Further investigations are warranted to continue to evaluate patient tolerance and safety with BFRT, because while these preliminary results suggest a positive safety profile and good tolerance in the adolescent population after ACLR, they represent the experiences of only a small sample. Level of Evidence Level 3
Background: The incidence of anterior cruciate ligament (ACL) injuries have been consistently increasing in adolescents, with those who return to competitive sport having up to a 32% risk of a secondary ACL injury. There is limited evidence regarding knee strength outcomes in young adolescents following ACL reconstruction during late-stage rehabilitation when compared to older patient groups. Purpose: The purpose of this study was to 1) establish normative knee strength values according to age group in adolescent female and male patients during late-stage rehabilitation following ACLR and 2) determine whether strength differences exist between age groups. Methods: A retrospective review of adolescent patients who underwent primary ACL reconstruction was performed. Patients completed a standardized isokinetic (60°/sec) knee extension and flexion strength assessment during late-stage rehabilitation. Peak torque was normalized to the patient’s body mass (Nm/kg) and used to calculate Limb Symmetry Index (LSI). Analyses were conducted separately for female and male cohorts and grouped by early (11-14 years) and middle (15-17 years) adolescence. An independent samples t-test examined strength differences between age groups. Results: 130 females (age=15.4 ± 1.4 years; days since surgery=239.0 ± 84.4) and 112 males (age=15.4 ± 1.5 years; days since surgery= 232.6 ± 91.2) were included. Normalized knee extension peak torque on the involved limb was reported for female (1.5 Nm/kg) and male (1.8 Nm/kg) cohorts. Differences between age groups in knee extension peak torque were found on the surgical and nonsurgical limbs in female (p = 0.02 – 0.05) and male (p<0.001 – 0.002) cohorts. No differences were found between age groups for either cohort when normalized to body mass (p = 0.30 – 0.89). Post hoc power analyses revealed 67% statistical power in the female cohort and 97% in the male cohort with an alpha level set to 0.05 based on the observed effect size for the differences in isokinetic knee extension/flexion peak torque between age groups. Conclusion: Early adolescents produced less knee extension and flexion peak torque compared to middle adolescents after ACLR, but no differences were found between age groups when normalized to body mass for female or male cohorts. Normalized knee extension strength in young adolescents may differ from older patients and should be considered in the rehabilitation process. [Table: see text][Table: see text][Table: see text][Table: see text]
Background: The relationship between physical therapy (PT) visit utilization and performance during single-legged hop testing after anterior cruciate ligament reconstruction (ACLR) in young patients is unclear. Purpose: To examine the effect of PT utilization on hop testing performance in pediatric and adolescent patients after ACLR. Methods: A retrospective review of patients who underwent primary ACLR between 2013 and 2019 at 5 institutions was conducted. All patients followed a structured rehabilitation protocol as directed by the treating institution and completed a return to sport (RTS) test which included single-legged hop testing. PT frequency was assessed both overall and by time period (first 6 weeks, week 7-month 3, 3-6 months, and 6-12 months). PT visits were recorded up until the time of hop testing. To account for variability, the average number of visits attended per week during the observed time was calculated for each patient. The effect of PT visit rate on the odds of passing a hop test was assessed using multivariable logistic regression controlling for time to test, age, sex, and insurance status. Passing was defined as achieving a limb symmetry index (LSI) ≥ 90% on all available tests (single hop, triple hop, crossover hop, and timed hop, if performed), as well as passing just the single hop test. The primary predictor of interest included the average rate of PT visits at the time of hop test (≥1 visit per week vs. <1 visit per week). Results: 289 patients were identified (mean age, 15.7 ± 1.9 years). The mean time from surgery to the first PT visit was 0.36 ± 0.24 months. RTS testing was performed at a mean of 8.0 ± 1.9 months. Patients averaged 0.98 ± 0.38 visits per week until the RTS test. Mean LSIs for the single hop, triple hop, crossover hop, and timed hop were 96.3 ± 8.2, 97.1 ± 6.5, 98.5 ± 7.8, and 98.2 ± 7.4, respectively. 68.9% of patients passed all performed test; 85.5% passed the single hop test. The weekly rate of PT visits had no statistically significant effect on the odds of passing all performed hop tests (OR, 0.98; 95% CI, 0.56-1.71) or the single hop test (OR, 1.05; 95% CI, 0.51-2.18). Furthermore, the distribution of PT visits did not affect hop testing performance (Table 1). Conclusion: The rate and distribution of PT visit utilization was not associated with hop testing performance in pediatric and adolescent patients after ACLR. [Table: see text]
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