Effect of Blood Flow Restriction Training on Patient With Anterior Cruciate Ligament Reconstruction
Condition: Anterior Cruciate Ligament Injuries; Atrophy; Muscle Weakness
MeSH terms: Muscle Weakness; Atrophy; Anterior Cruciate Ligament Injuries
Study type: Interventional

Summary: 
      This study investigates the effects of plyometric training with blood flow restriction on
      muscular strength, quadriceps thickness and knee joint function in patients with muscle
      weakness and atrophy (quadriceps muscle and hamstring muscle) after anterior cruciate
      ligament reconstruction. Persons who completed a 12-week routine rehabilitation program after
      anterior cruciate ligament reconstruction will be included in the study. In the study group,
      plyometric exercises will be performed with blood flow restriction in the operated side for 8
      weeks. In the control group, the same plyometric exercises will be performed without any
      application.
    

Detailed 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.
    

Intervention name(s): Plyometric exercise with blood flow restriction; Plyometric exercise; Routine physiotherapy program
Intervention type(s): Other; Other; Other
Intervention description(s): 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); 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); Anterior and lateral plan exercise (3x10 rep) Open kinetic quadriceps and hamstring strengthening exercise (3x10 rep) Lunge exercises on different ground (3x10 rep) Single leg squat exercise on different ground (3x10 rep) Anterior and lateral walking exercise in a squatting position with an exercise band (40 step) Balance and proprioceptive exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: anterior cruciate ligament reconstruction; atrophy; knee function