Outcomes of Blood Flow Restriction Therapy as an Adjunct to Standard Rehabilitation Following Anterior Cruciate Ligament Reconstruction: A Prospective Observational Cohort Study

Abstract

Abstract Introduction: Quadriceps weakness and muscle atrophy remain major challenges following anterior cruciate ligament (ACL) reconstruction. Blood flow restriction (BFR) therapy enables low-load resistance training and may enhance early rehabilitation outcomes. This study evaluated the clinical and radiological outcomes of adding BFR therapy to standard post-operative rehabilitation. Materials and Methods: In this prospective observational cohort study, 40 patients (18–45 years) undergoing arthroscopic ACL reconstruction received standard rehabilitation supplemented with BFR therapy (60–80% limb occlusion pressure) from post-operative day 1 for 16 weeks. The primary outcome was quadriceps cross-sectional area (CSA) on magnetic resonance imaging. Secondary outcomes included Numeric Pain Rating Scale (NPRS), thigh girth, and Lysholm score. Paired t-tests were used for analysis. Results: Mean age was 28.25 ± 7.15 years, with 90% male. NPRS increased on post-operative day 1 (P < 0.0001) and significantly decreased thereafter (P ≤ 0.001). Lysholm scores improved from 70.57 ± 7.37 to 88.82 ± 5.38 (P < 0.0001), exceeding the minimal clinically important difference. Thigh girth remained unchanged (P > 0.05). Quadriceps CSA showed a non-significant reduction (approximately 6%; P = 0.123). Conclusion: BFR therapy is a safe and well-tolerated adjunct to standard ACL rehabilitation, associated with improved functional outcomes and pain while preserving muscle mass. Larger randomized controlled trials with longer follow-up are required to validate these findings.