Early BFR Training Post Meniscus & Cartilage Repair

A newly published study has explored the feasibility of a partly self-administrated BFR training program post-op.

Background: Cartilage or meniscus repairs are common procedures, in which patients early post-op are often restricted from full weight-bearing and high-impact activities. Pain and/or expectations of pain or even negative events may potentially limit the use of BFR- in clinical practice?

Aim: To determine the feasibility of BFR Training added to standard care in patients post cartilage or meniscus repair.

Method:

Prospective, exploratory study to evaluate the feasibility of partly Self-Administered BFR Training (SAT). Patients followed a usual care exercise pathway in a common clinical practice setting in Denmark.

Inclusion criteria: 18 and 70 years of age, cartilage or meniscus repair who were not allowed full weight bearing post-op.

Exclusion criteria: Commonly used risk assessment tools to prevent serious events.

Frequency: 5/weekly; 2/weekly (supervised) and 3/weekly as SAT.

Exercise: Only knee extensions with elastic band or machine.

Load: Without external load for 1-6 weeks Range of motion: Max. 90°. With external load for the following 6 weeks (20–40% of 1RM). No traditional strength training from week 7 to 12 post-op.

Reps: week 1-6, 4 sets as 30x15x15xfailure (max 30 reps). Rest between sets: 30–45 s. From +6 weeks: 30x15x15x15 reps + external load.

Pressure: 80% Limb Occlusion Pressure (LOP) then educating the patients to replicate this pressure with an elastic band for SAT. The pressure was assessed via an inflatable cuff (20 cm wide) and SAT with the elastic band.

Assessment: Week 4-6, 3 times. Week, 7-12, 16 times as group training. Week 16 and 26 once, respectively.

Outcome measures: Adherence, adverse events, knee-related symptoms, muscle mass, and clinical outcomes.

Results:

Completion: +84% of the BFR- supervised sessions. 146 mild adverse events, none were considered serious. No decrease in thigh girth.

No exacerbation of joint or muscle pain.

Discussion:

Patients adhered well to the protocol without any related reports of serious adverse events or exacerbation of knee-related symptoms. No disuse atrophy of the thigh muscles was found, despite patients having restrictions on weight-bearing.

This BFR protocol can most likely be applied directly to clinical practice. Though, patients were primarily young and had free access to their treatment.

Conclusions:

Patients were able to adhere to high-volume, high-intensity, low-load BFR training for 9 weeks. Only mild harms were reported, but no serious adverse events were found. BFR added to usual care exercise initiated early post cartilage or meniscus repair seems feasible and may prevent thigh muscle atrophy during a period of weight-bearing restrictions.

The preliminary findings are promising and an RCT is warranted to explore the efficacy of early BFR in a similar population.

Primary Source: Jakobsen et al. (2022) Blood flow restriction added to usual care exercise in patients with early weight bearing restrictions after cartilage or meniscus repair in the knee joint: a feasibility study

Secondary Source: Barber-Westin et al. (2020) Blood Flow-Restricted Training for Lower Extremity Muscle Weakness due to Knee Pathology- A Systematic Review

Cuyul-Vasquez et al. (2020) The addition of blood flow restriction to resistance exercise in individuals with knee pain- a systematic review and meta-analysis

Cant et al. (2020) Quadriceps strengthening with blood flow restriction for the rehabilitation of patients with knee conditions- A systematic review with meta-analysis

Lorenz et al. (2021) Current Clinical Concepts- Blood Flow Restriction Training

Bielitzki et al (2021) Time to Save Time- Beneficial Effects of BFR and the Need to Quantify the Time Potentially Saved by its Application during Musculoskeletal Rehabilitation.