Blood Flow Restriction Training After ACL Reconstruction with Hamstring Autograft: Impact on Tendon Regeneration & Hamstring Muscle Recovery – A Double-Blind Trial

Effects of Blood Flow Restriction Training After Anterior Cruciate Ligament Reconstruction with Hamstring Autograft on Tendon Regeneration and Physical Properties of the Donor Hamstring Muscle: A Randomized Double-blind Sham-controlled Trial

Authors

Ashokan Arumugam¹, Ibrahim Moustafa¹, Mustafa Jabreen², Matthew Kilgas³, Azzam Kamal², Borja Merry del Val², Faris Almallah², Željko Banićević ⁴, Ivana Banićević⁴.

¹Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
²Physiotherapy and Rehabilitation Department, Healthpoint Hospital, UAE.
³School of Health & Human Performance , Northern Michigan University, USA.
⁴HERC – Health, Exercise & Research Center, Dubai, UAE.

Phase

Grant application submitted.

The Project

Background:

One important advantage for hamstring autograft after anterior cruciate ligament (ACL) reconstruction is the high potential of tendon regeneration at the donor site. Complete tendon regeneration may happen late, and different levels of neo-tendon insertion are described. Away from that, rehabilitation following ACL reconstruction might be challenging because optimal loading of the ACL mainly during early stages needs careful consideration. For this reason, blood flow restriction (BFR) combined with low load training is indicated to overcome the post-surgical muscle weakness and atrophy. However, determinants of tendon regeneration including the possible role of post-operative rehabilitation are not yet ascertained.

Objective:

The purpose of this trial is to study the effects of BFR training on hamstring tendon regeneration, and its effects on the muscle strength, function and performance following ACL reconstruction with a hamstring autograft.

Design:

A randomized, double-blinded, two-arm parallel group, sham-controlled clinical trial.

Setting:

The trial will take place at the Physiotherapy and Rehabilitation Department of Healthpoint hospital in Abu Dhabi, United Arab Emirates.

Intervention:

Participants will be randomly assigned to either BFR treatment or sham BFR treatment groups which will be added to the hospital standard rehabilitation protocol.

Outcome measures:

The primary outcome measures include hamstring maximum voluntary isometric contraction (MVIC) and tendon regeneration. The secondary outcome measures include joint effusion, thigh muscles size, passive joint position sense, Y balance test, quadriceps MVIC, isokinetic concentric hamstring and quadriceps strength, ACL laxity, numeric pain rating scale, international knee documentation committee, Tegner activity scale, and Tampa scale for kinesiophobia.

Significance of the study:

This novel therapy (BFR training) might augment hamstring tendon regeneration, better functional improvements, and improved knee-related quality of life as well as aid in optimal return to sports in sportspeople with anterior cruciate ligament injuries managed with surgical reconstruction.14:41