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

Abstract

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.

Blood flow restriction training promotes functional recovery of knee joint in patients after arthroscopic partial meniscectomy: A randomized clinical trial

“…A possible explanation is that BFRT enhances neuromuscular control of the lower extremities by increasing proprioceptive input. However, it must be admitted that a few studies have reached conflicting conclusions: there was no significant difference in quadriceps strength changes in the BFRT group compared with the routine rehabilitation training group ( Mason et al, 2022 ). The possible reason is that the exercise load of the participants was lower than 20%–30% of 1RM, resulting in an insufficient number of motor units devoted to muscle contraction, resulting in no significant increase in muscle strength.…”

Effectiveness of Blood Flow Restriction on Functionality, Quality of Life and Pain in Patients with Neuromusculoskeletal Pathologies: A Systematic Review

“…According to the IBMFRS, the control group decreased both sections by up to 17 points compared to the BFR intervention group, which could be due to the fact that they did not perform any particular activity [28] or that the level of self-efficacy was maintained in those patients who practiced exercise [61]. The same is true for the medium-term follow-up where the control group improved compared to the BFR intervention group by 11 points [39]. This may be due to the loss of BFR intervention properties such as metabolic stress when this adjuvant treatment is withdrawn, despite continued exercise [62].…”

“…The BFR intervention group improved function by 14.81 points on the Lower Extremity Function Scale (LEFS) and 14.83 on the Lysholm Knee-Scoring Scale as a result of better adaptation to low loads. However, the Knee Osteoarthritis Outcome Score (KOOS) showed benefits in the control group for pain with 10.33 points, and symptoms with 12.33 points, and in the BFR intervention group for activities of daily living with 10.5 points, and quality of life with 14.38 points [37,39]. Despite these data, the differences between high loads or low loads with BFR intervention were not large, providing the same benefits for functionality in anterior cruciate ligament reconstruction.…”

New frontiers for cartilage repair, joint preservation and prevention

“…10 Although enough evidence of BFR-TR efficacy on knee OA is lacking, the results favor its use for muscle strengthening and pain reduction in knee OA and other knee conditions. 11 , 12 One study has been focusing on specially using BFR for cartilage repair patients 13 and 2 studies on BFR training and cartilage injuries are listed at ClinicalTrials.gov site ( https://clinicaltrials.gov/ ).…”