EFFECTS OF BLOOD FLOW RESTRICTION WITH AND WITHOUT TOTAL MOTION RELEASE ON RANGE OF MOTION IN POST-OPERATIVE ACL INJURY: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background and Objectives: One key component of the rehabilitation process following anterior cruciate ligament (ACL) reconstruction is restoration of knee range of motion (ROM), and maintaining a functional range of motion without excessive flexion or terminal extension deficit is important for promoting gait normalization and functional recovery. This RTC compared the influence of Blood Flow Restriction + Total Motion Release (BFR+TMR) on knee ROM in the rehabilitation of ACL injury. Methods: Forty-four patients who underwent ACL reconstruction surgery were randomly assigned to the BFR group (n = 22) and BFR + TMR group (n = 22). ROM was measured at baseline, 6 weeks, 12 weeks and 6 months for knee flexion of injured limb, knee extension deficit of injured limb, knee flexion of non-injured limb and knee extension deviation of non-injured limb. Two-way mixed ANOVA with time (the within-subjects factor) and group (the between-subjects factor) was used to analyze data. Results: All outcomes of the ROM showed significant time effects and Time × Group interactions. Injured-limb flexion improved from 63.05 ± 5.00 degrees to 93.86 ± 5.48 degrees in the BFR group and from 64.27 ± 5.36 degrees to 127.91 ± 4.47 degrees in the BFR+TMR group, with a significant Time × Group interaction, F(3,126) = 355.17, p < .001, partial eta squared = .894. There was also a significant interaction for injured-limb extension deficit, with the BFR group showing improvement of -0.82 ± 0.73 degrees and BFR+TMR group showing improvement of -0.14 ± 0.35 degrees, F(3,126) = 7.93, p < .001, partial eta squared = .159. There was also a significant interaction effect between the non-injured limb flexion and extension. Conclusion: In the framework of ACL injury rehabilitation, the use of Total Motion Release in addition to BFR yielded significantly higher and quicker ROM recovery compared to BFR alone. This combination of protocols can clinically be beneficial in enhancing knee flexion, terminal extension and bilateral movement symmetry. Clinical Trial Number: NCT07589309