Effect of Blood Flow Restriction Training on Quadriceps Muscle Performance Following ACL Reconstruction: A Systematic Literature Review
Keywords:
Anterior Cruciate Ligament, ACL Reconstruction, Blood Flow Restriction , Training, Quadriceps muscle, Muscle performanceAbstract
Background: Owing to disadvantage of conventional rehabilitation, there is need for specific intervention to overcome muscle atrophy or deficits following anterior cruciate ligament reconstruction (ACLR). This clinically significant quadriceps muscle deficiency led to knee pain and biochemical disruptions.
Objective: The study aimed to determine the effectiveness of blood flow restriction therapy (BFRT) in the enhancement of clinical outcomes such as muscle strength, muscle size, patient-reported outcomes, and functional performance.
Methodology: A systematic review was conducted following Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 guidelines. The literature was searched on PubMed, Scopus and Cochrane library. The search was limited to only articles written in English and published between 1st January 2020 and 31st August 2025. Risk of bias (ROB) was assessed using Cochrane Risk of Bias (ROB) 2.0. The narrative synthesis and data driven iterative approach was used to synthesize evidence. P-value < 0.05 was taken to determine statistical significance.
Results: The initial database search yielded 105 articles. After removing (20) duplicates, the titles and abstracts of 85 articles were screened for relevance. Sixty (65) articles were excluded due to irrelevant titles and abstracts. One article did not retrieve full text. The remaining full text of 19 articles was assessed, and 7 met eligibility criteria. The 7 RCTs were included to synthesize evidence.
Conclusion: BFRT reported mixed effectiveness for patients underwent ACLR. One model for BFRT incorporation in ACLR rehabilitation emphasize its use in the early post-operative period (2-8 weeks) with low-load resistance training (<30% 1RM) and then implementing it mid-term when high load training (>70% 1RM) is not tolerated. There is clear evidence that 80% or higher AOP/LOP is the ideal dose for muscle strength and size. However, evidence also synthesized that BFRT as an adjuvant to high-intensity protocols reduce knee pain initially but no long-term outcomes. Some RCTs also examined that BFRT did not provide superior role to conventional rehabilitation (pre- or peri). Therefore, future RCTs are emphasized to validate the findings.
