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Review
. 2024 Oct 20;13(20):6265.
doi: 10.3390/jcm13206265.

Blood Flow Restriction Training and Its Use in Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Jamaal Butt  1 , Zubair Ahmed  1   2
Affiliations
Review

Blood Flow Restriction Training and Its Use in Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Jamaal Butt et al. J Clin Med. .

Abstract

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction (ACLR) is often followed by significant muscle atrophy and subsequent loss of strength. Blood flow restriction training (BFRT) has recently emerged as a potential mode of rehabilitation to mitigate these effects. The goal of this systematic review was to evaluate the efficacy of BFRT in functional recovery when compared to traditional rehabilitation methods. Methods: A literature review was conducted across July and August 2024 using multiple databases that reported randomised controlled trials comparing BFRT to traditional rehabilitation methods. Primary outcomes were changes to thigh muscle mass and knee extensor/flexor strength with secondary outcomes consisting of patient-reported functional measures (IKDC and Lysholm scores). The RoB-2 tool was used to assess the risk of bias. Results: Eight studies met the inclusion criteria; however, substantial heterogeneity prevented a meta-analysis being conducted for the primary outcomes. Three out of the five studies measuring muscle mass reported significant (p < 0.05) findings favouring BFRT. There was variation amongst the strength improvements, but BFRT was generally favoured over the control. Meta analysis of the secondary outcomes showed significant improvements (p < 0.05) favouring BFRT despite moderate heterogeneity. Conclusions: BFRT shows promise for maintaining muscle mass and improving patient reported outcomes following ACL reconstruction. However, the high risk of bias limits the strength of these conclusions. Further high-quality research needs to be conducted to establish optimal BFRT protocols for this cohort and to determine if BFRT has a place in ACL rehabilitation.

Keywords: ACLR; anterior cruciate ligament; blood flow restriction training; functional recovery; rehabilitation.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Risk of bias assessment. (A) summary of risk of bias in all studies. (B) Risk of bias in individual studies for each domain [9,27,28,29,30,31,32,33].
Figure 3
Figure 3
Meta-analysis of secondary outcome data for IKDC scores in appropriate studies [9,29,30,33].
Figure 4
Figure 4
Meta-analysis of secondary outcome data for Lysholm scores in appropriate studies [9,29,33].
See this image and copyright information in PMC

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