Blood Flow Restriction Therapy After Anterior Cruciate Ligament Reconstruction.

Autor:	Johns WL; Thomas Jefferson University Hospital and Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A.. Electronic address: william.johns@jefferson.edu., Vadhera AS; Thomas Jefferson University Hospital and Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A., Hammoud S; Thomas Jefferson University Hospital and Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A.
Jazyk:	angličtina
Zdroj:	Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2024 Jun; Vol. 40 (6), pp. 1724-1726.
DOI:	10.1016/j.arthro.2024.03.004
Abstrakt:	Anterior cruciate ligament reconstruction (ACLR) rehabilitation necessitates restoration of quadriceps strength to minimize reinjury and optimize return to sport (RTS). Patients recovering from ACLR are limited by pain and activity restrictions, resulting in quadriceps muscle atrophy. Blood flow restriction (BFR) therapy involves performing exercises while a specialized blood pressure cuff is applied to the proximal aspect of the operative extremity and inflated to 40% to 90% of the arterial occlusion pressure, as determined using Doppler ultrasonography. BFR is theorized to induce an anaerobic environment and metabolic stress during exercise, promoting muscle hypertrophy and strength gains. Although the physiological mechanism has not been fully elucidated, it is theorized that BFR combined with low-load resistance training could yield muscle adaptations comparable to those of high-load resistance training. For ACLR patients with pain and restrictions precluding high-intensity strength training, incorporation of BFR into postoperative rehabilitation protocols could help mitigate quadriceps weakness and promote RTS. Randomized controlled trials report a prolonged, dose-dependent relation between BFR use and quadriceps and hamstring strength gains, improved bone and muscle mass, and earlier RTS, whereas other studies report no significant difference in quadriceps size, strength, or patient satisfaction compared with controls. Furthermore, although generally considered safe, there are rare reports of associated adverse events such as rhabdomyolysis, and BFR should be avoided in patients with a history of thromboembolic disease or peripheral vasculopathy. The literature examining BFR after ACLR is heterogeneous; lacks standardization; and contains broad variation in reported cuff pressures, as well as timing and duration of BFR use, among protocols. Although the use of BFR after ACLR shows promise, further study is necessary to elucidate the efficacy, safety, and optimal protocols. Competing Interests: Disclosures The authors report the following potential conflicts of interest or sources of funding: S.H. is a consultant for Arthrex, outside the submitted work, and is board or committee member of American Orthopaedic Society for Sports Medicine, Orthopaedic Learning Center, and Perry Initiative. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material. (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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