Effect of Blood Flow Restriction Training on Patient With Anterior Cruciate Ligament Reconstruction
Keywords
Abstract
Description
Anterior cruciate ligament (ACL) rupture is one of the most common sports injuries. Surgical procedure is usually performed after injury. After ACL surgery, patients experience problems such as pain, impaired knee function, and especially quadriceps muscle weakness and atrophy. Quadriceps atrophy has been shown to persist for years despite rehabilitation programs. Therefore, rehabilitation programs after ACL reconstruction play an important role in ensuring return to sports and reducing postoperative complications. In general, ACL rehabilitation can be divided into early and late periods. In the early period, while focusing on the solution of the primary problems related to the knee (pain, edema, joint movement limitation, quadriceps muscle weakness, and antalgic gait), the focus is on the patient's preparation for returning to sports activities. Running, jumping and agility training are the exercise approaches of late phase rehabilitation. These exercises include pliometric activities that trigger the stretch-shortening cycle of the lower extremity extensor muscles. Pliometric exercises after anterior cruciate ligament reconstruction may improve lower extremity muscle strength and knee function and increase the rate of return to sports, but there is not enough study in this area. Under normal conditions, 6-12 repetitive weight-lifting exercises at a density of at least 65% of a maximum repetition are recommended to increase strength in a muscle and achieve hypertrophy. However, it takes approximately 4-6 months for the ligament to mature and bear weight after surgery. For this reason, high intensity strengthening training is not used in the early period of rehabilitation to protect the graft that is recovering after surgery and the training is started from low intensity and increased gradually. Recent studies suggest that muscle hypertrophy occurs with low-intensity exercises (20-30% of a maximum repetition) with blood flow restriction, also known as KAATSU training or occlusion training. Because blood flow restriction training allows the benefits of high intensity training to be obtained at a much lower intensity. In the literature, the effectiveness of many different exercise programs after ACL reconstruction was investigated. However, no study investigating the effect of blood flow restriction plyometric exercise training on ACL rehabilitation on muscle strength and function was found. This study will be conducted to investigate the contribution of low-density plyometric training with blood flow restriction to atrophy, muscle strength, function and return to sports.
Dates
| Last Verified: | 01/31/2020 |
| First Submitted: | 01/06/2020 |
| Estimated Enrollment Submitted: | 02/24/2020 |
| First Posted: | 02/25/2020 |
| Last Update Submitted: | 02/24/2020 |
| Last Update Posted: | 02/25/2020 |
| Actual Study Start Date: | 12/09/2018 |
| Estimated Primary Completion Date: | 03/14/2020 |
| Estimated Study Completion Date: | 03/14/2020 |
Condition or disease
Intervention/treatment
Other: Plyometric training with blood flow restriction
Other: Plyometric training
Other: Routine physiotherapy program
Phase
Arm Groups
| Arm | Intervention/treatment |
|---|---|
| Experimental: Plyometric training with blood flow restriction Routine physiotherapy program + Plyometric training with blood flow restriction, 3 days a week for 8 weeks Jump in functional squat system (30+15+15+15= 75 rep) Lunge jump (30 rep) Side jump (30 rep) Box jump (15 rep) Exercises to be added after 4 weeks; Square jump (15 rep) One leg hop (15 rep) | Other: Plyometric training with blood flow restriction Blood flow restriction training is an exercise protocol based on the method of limiting blood flow with external pressure by pneumatic tourniquet from the proximal of the muscle to be strengthened. Blood flow restriction (Occlusion) during pliometric exercises for 8 weeks, a pneumatic tourniquet (Kaatsu Master) proximal to the thigh will be applied to each patient within a safe pressure range. The pressure to be applied to the patient will be calculated with the following formula described in the literature.
Pressure = 0.5 x (systolic blood pressure) + 2 x (thigh circumference) + 5 Application will be done for a maximum of 15 minutes, then rest for 10-15 minutes and other exercises will continue.
Plyometric training with blood flow restriction. Jump in functional squat system (30+15+15+15= 75 rep) Lunge jump (30 rep) Side jump (30 rep) Box jump (15 rep) Exercises to be added after 4 weeks; Square jump (15 rep) One leg hop (15 rep) |
| Active Comparator: Plyometric training Routine physiotherapy program + Plyometric training 3 days a week for 8 weeks Jump in functional squat system (30+15+15+15= 75 rep) Lunge jump (30 rep) Side jump (30 rep) Box jump (15 rep) Exercises to be added after 4 weeks; Square jump (15 rep) One leg hop (15 rep) | Other: Plyometric training Plyometric training Jump in functional squat system (30+15+15+15= 75 rep) Lunge jump (30 rep) Side jump (30 rep) Box jump (15 rep) Exercises to be added after 4 weeks; Square jump (15 rep) One leg hop (15 rep) |
Eligibility Criteria
| Ages Eligible for Study | 18 Years To 18 Years |
| Sexes Eligible for Study | All |
| Accepts Healthy Volunteers | Yes |
| Criteria | Inclusion Criteria: - Age between 18-45 year - Volunteering to participate in the study - Patients who had unilateral anterior cruciate ligament surgery with hamstring tendon auto graft and completed 12 weeks of rehabilitation program Exclusion Criteria: - Systemic or neurological problems - Endothelial dysfunction - Peripheral vascular diseases and history of deep vein thrombosis - Active infection, cancer, pregnant, - Posterior cruciate ligament tear, medial or lateral collateral ligament tear and knee cartilage damage |
Outcome
Primary Outcome Measures
1. Quadriceps muscle thickness and rectus femoris cross-sectional ares [8 week]
2. Hamstring and quadriceps muscle strength [8 week]
Secondary Outcome Measures
1. Vertical jump test (VJT) [8 week]
2. One leg hop test (OLHT) [8 week]
3. Single leg triple hop test (SLTHT) [8 week]
4. Y balance test [8 week]
5. Knee Documentation Committee (IKDC) Questionnaire [8 week]
6. Knee Injury and Osteoarthritis Outcome Questionnaire (KOOS) [8 week]
7. Tampa Kinesiophobia Scale [8 week]
8. Anterior Cruciate Ligament Return to Sport After Injury Scale (ACL-RSI) [8 week]
