Blood Flow Restriction Training Can Improve Peak Torque Strength in Chronic Atrophic Postoperative Quadriceps and Hamstrings Muscles

Abstract

Purpose: To report a prospective study of patients who underwent blood flow restriction training (BFRT) for marked quadriceps or hamstring muscle deficits after failure to respond to traditional rehabilitation after knee surgery.

Methods: The BFRT protocol consisted of 4 low resistance exercises (30% of 1 repetition maximum): leg press, knee extension, mini-squats, and hamstring curls with 60% to 80% limb arterial occlusion pressure. Knee peak isometric muscle torque (60° flexion) was measured on an isokinetic dynamometer.

Results: Twenty-seven patients (18 females, 9 males; mean age, 40.1 years) with severe quadriceps and/or hamstrings deficits were enrolled from April 2017 to January 2020. They had undergone a mean of 5.3 ± 3.5 months of outpatient therapy and 22 ± 10 supervised therapy visits and did not respond to traditional rehabilitation. Prior surgery included anterior cruciate ligament reconstruction, partial or total knee replacements, meniscus repairs, and others. All patients completed 9 BFRT sessions, and 14 patients completed 18 sessions. The mean quadriceps and hamstrings torque deficits before BFRT were 43% ± 16% and 38% ± 14%, respectively. After 9 BFRT sessions, statistically significant improvements were found in muscle peak torque deficits for the quadriceps (P = .003) and hamstring (P = .02), with continued improvements after 18 sessions (P = .004 and P = .002, respectively). After 18 BFRT sessions, the peak quadriceps and hamstring peak torques increased > 20% in 86% and 76% of the patients, respectively. The failure rate of achieving this improvement in peak quadriceps and hamstring torque after 18 BFRT sessions was 14% and 24%, respectively.

Conclusions: BFRT produced statistically significant improvements in peak quadriceps and hamstring torque measurements after 9 and 18 sessions in a majority of patients with severe quadriceps and hamstring strength deficits that had failed to respond to many months of standard and monitored postoperative rehabilitation.

Level of evidence: Level IV therapeutic case series.