Influence Of Blood Flow Restriction Training on Knee Pain After Anterior Cruciate Ligament Reconstruction: A Double Blinded Randamized Controlled Trial

Main Article Content

Ahmed A. Khalil
Nadia A. Fayaz
Enas Fawzy
Nabil A. Mohamed
Ahmed H. Waly
Maha M. Mohammed

Keywords

Blood flow restriction technique; Anterior cruciate ligament reconstruction; Conventional rehabilitation; Knee pain ; Pain scale

Abstract

Background: Anterior cruciate ligament rupture thought to be one of the most popular injuries among adults. Knee pain is a common post-operative rehabilitation problem, which may disturb muscle physiological prosperities and hinder the fluence of post-operative rehabilitation milestones achievement and vise versa. Blood flow restriction is an innovative technique which positively affects postoperative knee function.
Purpose: To investigate the effect of adding Blood flow restriction to post-operative anterior cruciate ligament conventional rehabilitation protocol on knee pain.
Methods: Thirty six post-operative anterior cruciate ligament post-operative patients were randomized into two groups. Participants in group I received conventional rehabilitation protocol. Participants in group II received blood flow restriction training added to conventional rehabilitation protocol. Knee pain was evaluated using a visual analogue scale pre-operative and one and half months and three months post-operatively.


Results: There was significant improvement of knee pain on visual analogue scale post-operative at all measures in both groups (p-value<0.05), while there was no significant differences between both groups at post-operative measures (p-value>0.05).
Conclusions: Adding blood flow restriction technique to conventional rehabilitation protocol was not superior to conventional rehabilitation protocol alone on knee pain post anterior cruciate ligament reconstruction

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References

1. Majewski, M., Susanne, H., & Klaus, S. (2006). Epidemiology of athletic knee injuries: A 10-year study. The knee, 13(3), 184-188.
2. Sanders, T.L., Maradit Kremers, H., Bryan, A.J., Larson, D.R., Dahm, D.L., Levy, B.A., Stuart, M.J. and Krych, A.J., (2016). Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. The American journal of sports medicine, 44(6),.1502-1507.
3. Akima, H., & Furukawa, T. (2005). Atrophy of thigh muscles after meniscal lesions and arthroscopic partial menisectomy. Knee Surgery, Sports Traumatology, Arthroscopy, 13(8), 632-637.
4. Thomas, A. C., Wojtys, E. M., Brandon, C., & Palmieri-Smith, R. M. (2016). Muscle atrophy contributes to quadriceps weakness after anterior cruciate ligament reconstruction. Journal of Science and Medicine in Sport, 19(1), 7-11.
5. Runner, R. P., Boden, S. A., Godfrey, W. S., Premkumar, A., Samady, H., Gottschalk, M. B., & Xerogeanes, J. W. (2018). Quadriceps strength deficits after a femoral nerve block versus adductor canal block for anterior cruciate ligament reconstruction: a prospective, single-blinded, randomized trial. Orthopaedic Journal of Sports Medicine, 6(9), 2325967118797990.
6. Hart, J. M., Diduch, D. R., & Baker, A. G. (2010). Clinical perceptions of arthrogenic muscle inhibition. Athletic Training & Sports Health Care, 2(4), 160-162.
7. Marcon, M., Ciritsis, B., Laux, C., Nanz, D., Nguyen-Kim, T. D. L., Fischer, M. A., ... & Ulbrich, E. J. (2015). Cross-sectional area measurements versus volumetric assessment of the quadriceps femoris muscle in patients with anterior cruciate ligament reconstructions. European radiology, 25(2), 290-298.
8. O’reilly, S. C., Jones, A., Muir, K. R., & Doherty, M. (1998). Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Annals of the rheumatic diseases, 57(10), 588-594.
9. Hall, M. C., Mockett, S. P., & Doherty, M. (2006). Relative impact of radiographic osteoarthritis and pain on quadriceps strength, proprioception, static postural sway and lower limb function. Annals of the rheumatic diseases, 65(7), 865-870.
10. Kotsifaki, R., Korakakis, V., King, E., Barbosa, O., Maree, D., Pantouveris, M., ... & Whiteley, R. (2023). Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British Journal of Sports Medicine.
11. Scott, B. R., Loenneke, J. P., Slattery, K. M., & Dascombe, B. J. (2015). Exercise with blood flow restriction: an updated evidence-based approach for enhanced muscular development. Sports medicine, 45(3), 313-325.
12. Patterson, S. D., Hughes, L., Warmington, S., Burr, J., Scott, B. R., Owens, J., ... & Loenneke, J. (2019). Blood flow restriction exercise: considerations of methodology, application, and safety. Frontiers in physiology, 10, 533.
13. Pope, Z. K., Willardson, J. M., & Schoenfeld, B. J. (2013). Exercise and blood flow restriction. The Journal of Strength & Conditioning Research, 27(10), 2914-2926.
14. Manimmanakorn, A., Hamlin, M. J., Ross, J. J., Taylor, R., & Manimmanakorn, N. (2013). Effects of low-load resistance training combined with blood flow restriction or hypoxia on muscle function and performance in netball athletes. Journal of science and medicine in sport, 16(4), 337-342.
15. Gil, A. L., Neto, G. R., Sousa, M. S., Dias, I., Vianna, J., Nunes, R. A., & Novaes, J. S. (2017). Effect of strength training with blood flow restriction on muscle power and submaximal strength in eumenorrheic women. Clinical physiology and functional imaging, 37(2), 221-228.
16. Abe, T., Fujita, S., Nakajima, T., Sakamaki, M., Ozaki, H., Ogasawara, R., ... & Ishii, N. (2010). Effects of low-intensity cycle training with restricted leg blood flow on thigh muscle volume and VO2max in young men. Journal of sports science & medicine, 9(3), 452.
17. Staunton, C. A., May, A. K., Brandner, C. R., & Warmington, S. A. (2015). Haemodynamics of aerobic and resistance blood flow restriction exercise in young and older adults. European Journal of Applied Physiology, 115(11), 2293-2302.
18. May, A. K., Brandner, C. R., & Warmington, S. A. (2017). Hemodynamic responses are reduced with aerobic compared with resistance blood flow restriction exercise. Physiological reports, 5(3), e13142.
19. Hughes, L., Paton, B., Rosenblatt, B., Gissane, C., & Patterson, S. D. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. British journal of sports medicine, 51(13), 1003-1011.
20. Patterson, S. D., Hughes, L., Head, P., Warmington, S., & Brandner, C. (2017). Blood flow restriction training: a novel approach to augment clinical rehabilitation: how to do it. British journal of sports medicine, 51(23), 1648-1649.
21. Minniti, M. C., Statkevich, A. P., Kelly, R. L., Rigsby, V. P., Exline, M. M., Rhon, D. I., & Clewley, D. (2020). The safety of blood flow restriction training as a therapeutic intervention for patients with musculoskeletal disorders: a systematic review. The American Journal of Sports Medicine, 48(7), 1773-1785.
22. Takarada, Y., Takazawa, H., Sato, Y., Takebayashi, S., Tanaka, Y., & Ishii, N. (2000). Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. Journal of applied physiology.
23. Ohta, H., Kurosawa, H., Ikeda, H., Iwase, Y., Satou, N., & Nakamura, S. (2003). Low-load resistance muscular training with moderate
restriction of blood flow after anterior cruciate ligament reconstruction. Acta Orthopaedica Scandinavica, 74(1), 62-68.
24. Marissa, F. (2018). Effectivity of blood flow restriction training for gains in strength and trophism in patients with ACL injuries. MOJ Orthop Rheumatol, 10(6), 371-5.
25. Koc, B. B., Truyens, A., Heymans, M. J., Jansen, E. J., & Schotanus, M. G. (2022). Effect of Low-Load Blood Flow Restriction Training After Anterior Cruciate Ligament Reconstruction: A Systematic Review. International Journal of Sports Physical Therapy, 17(3), 334.
26. Tennent, D. J., Hylden, C. M., Johnson, A. E., Burns, T. C., Wilken, J. M., & Owens, J. G. (2017). Blood flow restriction training after knee arthroscopy: a randomized controlled pilot study. Clinical Journal of Sport Medicine, 27(3), 245-252.
27. Crichton, N. (2001). Visual analogue scale (VAS). J Clin Nurs, 10(5), 706-6.
28. Alghadir, A. H., Anwer, S., Iqbal, A., & Iqbal, Z. A. (2018). Test–retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. Journal of pain research, 851-856.
29. Patterson, S. D., Hughes, L., & Owens, J. (2019). Early postoperative role of blood flow restriction therapy to avoid muscle atrophy. In Return to Sport After ACL Reconstruction and Other Knee Operations (pp. 261-274). Springer, Cham.
30. Hughes, L., Patterson, S.D., Haddad, F., Rosenblatt, B., Gissane, C., McCarthy, D., Clarke, T., Ferris, G., Dawes, J. and Paton, B., (2019). Examination of the comfort and pain experienced with blood flow restriction training during post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: A UK National Health Service trial. Physical Therapy in Sport, 39, pp.90-98.
31. Giles, L., Webster, K. E., McClelland, J., & Cook, J. L. (2017). Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. British journal of sports medicine, 51(23), 1688-1694.
32. Curley, A., Galel, A., Fryar, C., Lewis, J., Wang, D., Fackler, N., & Chang, E. (2021). Early Use of Blood Flow Restriction Training with Low-Intensity Exercises following Anterior Cruciate Ligament Reconstruction Improves Quadriceps Strength and Post-Operative Pain: A Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine, 9(7_suppl4), 2325967121S00226.
33. Kim, K., Lee, H. Y., & Lim, S. J. (2016). Effects of increased standing balance on pain in patients with knee osteoarthritis. Journal of physical therapy science, 28(1), 87-89.
34. Jeong, H. S., Lee, S. C., Jee, H., Song, J. B., Chang, H. S., & Lee, S. Y. (2019). Proprioceptive training and outcomes of patients with knee osteoarthritis: a meta-analysis of randomized controlled trials. Journal of athletic training, 54(4), 418-428.