Effect of Blood Flow Restriction Training on Patient With Anterior Cruciate Ligament Reconstruction

NCT ID: NCT04284748

Last Updated: 2020-08-11

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-12-10
• Study Completion Date: 2020-06-15

Brief 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.

Conditions

Anterior Cruciate Ligament Injuries; Atrophy; Muscle Weakness

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Plyometric training with blood flow restriction

Routine physiotherapy program + Plyometric training with blood flow restriction, 3 days a week for 8 weeks 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)

Group Type: EXPERIMENTAL

Plyometric exercise with blood flow restriction

Intervention Type: OTHER

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)

Routine physiotherapy program

Intervention Type: OTHER

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

Plyometric training

Routine physiotherapy program + Plyometric training 3 days a week for 8 weeks 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)

Group Type: ACTIVE_COMPARATOR

Plyometric exercise

Intervention Type: OTHER

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)

Routine physiotherapy program

Intervention Type: OTHER

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

Interventions

Plyometric exercise with blood flow restriction

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)

Intervention Type: OTHER

Plyometric exercise

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)

Intervention Type: OTHER

Routine physiotherapy program

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

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Age between 18-45 year
• Volunteering to participate in the study
• Patients who had unilateral anterior cruciate ligament surgery with hamstring tendon auto graft and completed 12 weeks of rehabilitation program

Exclusion Criteria

• Systemic or neurological problems
• Endothelial dysfunction
• Peripheral vascular diseases and history of deep vein thrombosis
• Active infection, cancer, pregnant,
• Posterior cruciate ligament tear, medial or lateral collateral ligament tear and knee cartilage damage

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 45 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Hacettepe University

OTHER

Sponsor Role: lead

Responsible Party

SERDAR DEMIRCI

Research Assistant

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Egemen Turhan, MD

Role: STUDY_DIRECTOR

Hacettepe University

Locations

Hacettepe University, Department of Physical Therapy and Rehabilitation

Ankara, , Turkey (Türkiye)

Countries

Turkey (Türkiye)

Other Identifiers

KA-180096

Identifier Type: -

Identifier Source: org_study_id