Practical implementation for BFR on post op ACLR or early weight bearing restrictions after cartilage or meniscus repair in the knee joint

The following are two recent BFR studies that got my attention. Especially the intervention programmes that easily can be implemented in your clinical practise.

Jakobsen TL, Thorborg K, Fisker J, Kallemose T, Bandholm T. Blood flow restriction added to usual care exercise in patients with early weight bearing restrictions after cartilage or meniscus repair in the knee joint: a feasibility study. J Exp Orthop. 2022

Jack RA 2nd, Lambert BS, Hedt CA, Delgado D, Goble H, McCulloch PC. Blood Flow Restriction Therapy Preserves Lower Extremity Bone and Muscle Mass After ACL Reconstruction. Sports Health. 2022

Other conditions were BFR has effect.

Jørgensen SL, Mechlenburg I. Effects of Low-Load Blood-Flow Restricted Resistance Training on Functional Capacity and Patient-Reported Outcome in a Young Male Suffering From Reactive Arthritis. Front Sports Act Living. 2021

Petersson N, Langgård Jørgensen S, Kjeldsen T, Mechlenburg I, Aagaard P. Blood Flow Restricted Walking in Elderly Individuals with Knee Osteoarthritis: A Feasibility Study. J Rehabil Med. 2022

Høgsholt M, Jørgensen SL, Rolving N, Mechlenburg I, Tønning LU, Bohn MB. Exercise With Low-Loads and Concurrent Partial Blood Flow Restriction Combined With Patient Education in Females Suffering From Gluteal Tendinopathy: A Feasibility Study. Front Sports Act Living. 2022

Return to play testing following anterior cruciate reconstruction – A systematic review & meta-analysis. Knee. 2022

Hurley ET, Mojica ES, Haskel JD, Mannino BJ, Alaia M, Strauss EJ, Jazrawi LM, Gonzlaez-Lomas G. Return to play testing following anterior cruciate reconstruction – A systematic review & meta-analysis. Knee. 2022

Recap

Introduction

The American Academy of Orthopaedic Surgeons (AAOS) released a one-page checklist consisting of patient-specific goals which must be met in order to clear an athlete to RTP following ACLR. These include graft incorporation, graft strength, functional range of motion, stability, strength, functional balance, functional skills, and confidence.

The purpose of the current study is to systematically review the evidence for RTP testing following ACLR, and determine whether it is predictive of re-injuries. Our hypothesis was that there would be a low pass rate in those undergoing RTP testing, but those who passed would have a lower risk of ACL graft rupture

Method

See flow chart.

Results

4.1. Return to play testing

Overall, 34.3% (420/1224) patients passed the RTP testing, with rates ranging between 18.8%88.1%. Those who passed the RTP testing had a statistically significant (47%) decrease in rate of ACL graft re-rupture compared to those who did not pass the RTP testing (RR; 0.53, 95% CI, 0.30–0.93, I2 = 32%, p = 0.03). Encourage to read full text.

4.2. Relationship between return to play testing threshold & subsequent ACL injury

There was a weak positive correlation between a high rate of patients passing the ACL RTP testing in studies and ACL graft rupture rate in those who passed (0.28). There was a weak negative correlation between a high rate of patients passing the ACL RTP testing in studies and contralateral ACL injury rate in those who passed (0.27). There was a strong positive correlation between a high rate of patients passing the ACL RTP testing in studies and ACL graft rupture rate in those who failed (0.80). There was a moderate negative correlation between a high rate of patients passing the ACL RTP testing in studies and contralateral ACL injury rate in those who failed (0.45). There was a weak positive correlation between a high rate of patients passing the ACL RTP testing in studies and total subsequent ACL rupture rate in those who passed (0.01). There was a moderate positive correlation between a high rate of patients passing the ACL RTP testing in studies and total subsequent ACL rupture rate in those who failed (0.63).

Discussion

The most important finding from our study was that passing RTP testing following ACLR results in a lower rate of ACL graft rupture, but not contralateral ACL ruptures. Overall, due to a slightly higher rate of contralateral ACL ruptures, passing
the ACL RTP testing did not lead to a lower rate of subsequent total ACL injury. Additionally, there was a low overall pass rate following current RTP testing measures. Furthermore, a high RTP pass rate (lower threshold for passing) correlated with a
high graft re-rupture rate in the group of patients who had failed RTP testing in those studies. This key finding suggests that a less stringent RTP testing battery may more specifically identify those who are at higher risk of re-tears. Overall, those who passed RTP testing were found to have a lower rate of ACL graft failure by almost a half. Additionally, in all but one study, there was a lower rate of re-injury following passing RTP testing. These findings suggest that RTP tests are a valid tool to screen for potential ipsilateral re-injury.

Conclusion

Our study established that passing RTP testing following ACLR results in a lower rate of ACL graft rupture, but not contralateral ACL injury. Additionally, there is a low overall pass rate following current RTP testing measures. Further refinement
of these criteria may be able to better and more specifically identify those who may be at a high risk of re-injury.