Dataset Information

Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength, Morphology, Physiology, and Knee Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: Protocol for a Randomized Clinical Trial.

ABSTRACT: BACKGROUND:Despite best practice, quadriceps strength deficits often persist for years after anterior cruciate ligament reconstruction. Blood flow restriction training (BFRT) is a possible new intervention that applies a pressurized cuff to the proximal thigh that partially occludes blood flow as the patient exercises, which enables patients to train at reduced loads. This training is believed to result in the same benefits as if the patients were training under high loads. OBJECTIVE:The objective is to evaluate the effect of BFRT on quadriceps strength and knee biomechanics and to identify the potential mechanism(s) of action of BFRT at the cellular and morphological levels of the quadriceps. DESIGN:This will be a randomized, double-blind, placebo-controlled clinical trial. SETTING:The study will take place at the University of Kentucky and University of Texas Medical Branch. PARTICIPANTS:Sixty participants between the ages of 15 to 40 years with an ACL tear will be included. INTERVENTION:Participants will be randomly assigned to (1) physical therapy plus active BFRT (BFRT group) or (2) physical therapy plus placebo BFRT (standard of care group). Presurgical BFRT will involve sessions 3 times per week for 4 weeks, and postsurgical BFRT will involve sessions 3 times per week for 4 to 5 months. MEASUREMENTS:The primary outcome measure was quadriceps strength (peak quadriceps torque, rate of torque development). Secondary outcome measures included knee biomechanics (knee extensor moment, knee flexion excursion, knee flexion angle), quadriceps muscle morphology (physiological cross-sectional area, fibrosis), and quadriceps muscle physiology (muscle fiber type, muscle fiber size, muscle pennation angle, satellite cell proliferation, fibrogenic/adipogenic progenitor cells, extracellular matrix composition). LIMITATIONS:Therapists will not be blinded. CONCLUSIONS:The results of this study may contribute to an improved targeted treatment for the protracted quadriceps strength loss associated with anterior cruciate ligament injury and reconstruction.

SUBMITTER: Erickson LN

PROVIDER: S-EPMC6665950 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength, Morphology, Physiology, and Knee Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: Protocol for a Randomized Clinical Trial.

Erickson Lauren N LN Lucas Kathryn C Hickey KCH Davis Kylie A KA Jacobs Cale A CA Thompson Katherine L KL Hardy Peter A PA Andersen Anders H AH Fry Christopher S CS Noehren Brian W BW

Physical therapy 20190801 8

<h4>Background</h4>Despite best practice, quadriceps strength deficits often persist for years after anterior cruciate ligament reconstruction. Blood flow restriction training (BFRT) is a possible new intervention that applies a pressurized cuff to the proximal thigh that partially occludes blood flow as the patient exercises, which enables patients to train at reduced loads. This training is believed to result in the same benefits as if the patients were training under high loads.<h4>Objective< ...[more]

PMID: 30951598

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Project description:BackgroundKnee joint kinematics and kinetics during running recover at 12 months, not 6 months, following anterior cruciate ligament (ACL) reconstruction surgery. Knee muscle strength is a criterion used to assess an individual's readiness to return-to-sports (RTS); however, the relationship between knee muscle strength and knee biomechanics is unclear. This study investigated the relationship between knee muscle strength and dynamic knee biomechanics during running at 6 and 12 months after ACL reconstruction surgery.MethodsKnee joint kinematics and kinetics during running were analyzed in 21 patients (10 males, 11 females) who underwent ACL reconstruction for a unilateral ACL deficiency. Kinematics and Kinetics were measured by three-dimensional motion analysis system, and Knee flexion angle was calculated using Point cluster technique and internal extension moment was calculated by the inverse dynamics method. Patients were compared to a control group matched by age, height and weight. Isokinetic knee extension and flexion strength in ACL-reconstructed patients were measured at 6 and 12 months postsurgery, by separated gender.ResultsKnee flexion angle was significantly lower in ACL patients at 6 months postsurgery compared to the control group (F (2, 62)=5.78, P=0.014). There were significant lower peak knee flexion angles in male groups than female (F (1, 62)=6.33, P<0.01). Knee extension moments were significantly lower in both male and female ACL patients compared to the control group at 6 and 12 months postsurgery (F (2, 62)=12.05, P<0.01(6 months), P=0.034(12 months)), and there were significant correlations with knee extension moments and maximum torque of knee extension/flexion (P<0.05). At 12 months after surgery, knee joint kinematics in ACL patients were restored. Both peak knee angle and knee extension moment were significantly associated with maximum knee extension/flexion torque values in female patients at 12 months postsurgery.ConclusionsDynamic knee biomechanics during running were not restored 6 and 12 months after ACL reconstruction both male and female. It is necessary to strengthen knee extension and flexion muscles to restore knee kinetics during running, especially female patients.

Project description:Context:Quadriceps function is a significant contributor to knee joint health that is influenced by central and peripheral factors, especially after anterior cruciate ligament reconstruction (ACLR).Objective:To assess differences of unilateral quadriceps isometric strength and activation between the involved limb and contralateral limb of individuals with ACLR and healthy controls.Data sources:Web of Science, SportDISCUS, PubMed, CINAHL, and the Cochrane Database were all used during the search.Study selection:A total of 2024 studies were reviewed. Twenty-eight studies including individuals with a unilateral history of ACLR, isometric knee extension strength normalized to body mass, and quadriceps activation measured by central activation ratios (CARs) through a superimposed burst technique were identified for meta-analysis. The methodological quality of relevant articles was assessed using a modified Downs and Black scale. Results of methodological quality assessment ranged from low to high quality (low, n = 10; moderate, n = 8; high, n = 10).Study design:Meta-analysis.Level of evidence:Level 2.Data extraction:Means, standard deviations, and sample sizes were extracted from articles, and magnitude of between-limb and between-group differences were evaluated using a random-effects model meta-analysis approach to calculate combined pooled effect sizes (ESs) and 95% CIs. ESs were classified as weak ( d < 0.19), small ( d = 0.20-0.49), moderate ( d = 0.50-0.79), or large ( d > 0.80).Results:The involved limb of individuals with ACLR displayed lower knee extension strength compared with the contralateral limb (ES, -0.78; lower bound [LB], -0.99; upper bound [UB], -0.58) and healthy controls (ES, -0.76; LB, -0.98; UB, -0.53). The involved limb displayed a lower CAR compared with healthy controls (ES, -0.84; LB, -1.18; UB, -0.50) but not compared with the contralateral limb (ES, -0.15; LB, -0.37; UB, 0.07). The ACLR contralateral limb displayed a lower CAR (ES, -0.73; LB, -1.39; UB, -0.07) compared with healthy control limbs but similar knee extension strength (ES, -0.24; LB, -0.68; UB, -0.19).Conclusion:Individuals with ACLR have bilateral CAR deficits and involved limb strength deficits that persist years after surgery. Deficits in quadriceps function may have meaningful implications for patient-reported and objective outcomes, risk of reinjury, and long-term joint health after ACLR.

Dataset Information

Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength, Morphology, Physiology, and Knee Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: Protocol for a Randomized Clinical Trial.

Publications

Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength, Morphology, Physiology, and Knee Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: Protocol for a Randomized Clinical Trial.

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