The Effects of Cross-Education with BFR on Quadriceps After ACLR

PURPOSE: The aim of this study was to compare the effects of cross-education training and cross-education (CE) and blood flow restriction (BFR) training on quadriceps strength and size recovery in patients with ACL reconstruction (ACLR).

METHODS: 23 patients (mean age 25.8±6.5 years, BMI: 23.8±2.2 kg/m2) who had undergone ACLR with HT autograft were included in the study. At 4 weeks after ACLR the patients were randomly divided into two groups;

•Group 1: CE

•Group 2: CE+BFR (Figure 1)

Both groups had standardized physiotherapy for their reconstructed limb until 12 weeks post-surgery and 8-week-training CE or CE+BFR that was started in uninvolved limb at 4 weeks after surgery.

•Group 1 performed CE at isokinetic system (quadriceps eccentric contraction, 60 °/s 3 set 12 rep, 2d/week).

•Group 2 performed the same CE procedure but the patients performed this training with BFR (KAATSU system) (Figure 2-3)

Quadriceps isometric strength was evaluated by isokinetic system and quadriceps muscle thickness (vastus medialis obliqus, rectus femoris, vastus lateralis) was measured by using ultrasound (Figure 4) at 4 weeks and 12 weeks after surgery.

Two-way repeated measures of ANOVA was performed for statistical analyses.

RESULTS: No significant differences were observed between groups for demographic characteristics, preinjury activity levels, and time from the injury to surgery (Table 1). There were no significant time by group interaction for quadriceps isometrics strength and size for involved and uninvolved limb (p>0.05). Main effect of time was significant for quadriceps strength and quadriceps size (rectus femoris (RF), vastus medialis obliqus (VMO), vastus lateralis (VL) in involved and uninvolved limbs (p<0.05) (Table 2).

CONCLUSION: The addition of blood flow training to eccentric quadriceps cross education does not have an effect on quadriceps strength and size recovery in reconstructed limb after ACLR when compared to eccentric cross education training alone. There is no need to use BFR to enhance the effect of cross education on quadriceps strength recovery but BFR maybe used in reconstructed limb to enhance quadriceps strength and size recovery after ACLR.