Related Experiment Video
Updated: May 8, 2026
Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Blood flow restriction as an adjunct during mid-stage rehabilitation after ACL reconstruction: a randomized
Qun-Ya Zheng1,2, Liang Chen1,2, Yan-Song Zhu1,2
1Department of Sports Medicine, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350005, PR China.
Purpose:
To determine whether adjunctive blood flow restriction (BFR) training during postoperative weeks 13-20 is associated with differences in functional, strength, balance, muscle morphology, and neuromuscular outcomes compared with sham BFR following anterior cruciate ligament reconstruction (ACLR).
Methods:
In this single-centre randomized controlled trial, 48 patients aged 18-35 years who underwent primary unilateral ACLR were randomly assigned to a BFR group or a Sham-BFR group. From postoperative weeks 13 to 20, both groups performed identical low-load resistance training (30% one-repetition maximum) twice weekly. The BFR group received individualized blood flow restriction at 40% arterial occlusion pressure, whereas the Sham-BFR group underwent the same protocol with minimal cuff pressure. Outcomes assessed at postoperative week 24 included the International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, knee range of motion (ROM), isometric knee extensor and flexor strength, quadriceps muscle thickness, Y-Balance Test performance, and quadriceps surface electromyography (sEMG).
Results:
Forty-three patients completed the study (BFR, n = 21; Sham-BFR, n = 22). At 24 weeks postoperatively, the BFR group demonstrated statistically significantly higher IKDC score and Tegner Activity Scale than the Sham-BFR group (p < 0.01). Knee extensor and flexor strength, Y-Balance Test composite scores, and quadriceps sEMG amplitudes were also significantly greater in the BFR group (p < 0.05). No significant between-group differences were observed in knee ROM or quadriceps muscle thickness.
Conclusion:
Adjunctive BFR training during mid-stage ACLR rehabilitation was associated with more favourable functional, strength, balance, and neuromuscular outcomes than sham BFR at 24 weeks postoperatively. These findings should be interpreted cautiously because baseline outcome measurements and immediate post-intervention assessments were not available.
Trial Registration:
(Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), No. ChiCTR2400087631, 31/07/2024).
