Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky.
Department of Rehabilitation Sciences and Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky.
Phys Ther. 2019 Aug 1;99(8):1010-1019. doi: 10.1093/ptj/pzz062.
Despite best practice, quadriceps strength deficits often persist for years after anterior cruciate ligament reconstruction. Blood flow restriction training (BFRT) is a possible new intervention that applies a pressurized cuff to the proximal thigh that partially occludes blood flow as the patient exercises, which enables patients to train at reduced loads. This training is believed to result in the same benefits as if the patients were training under high loads.
The objective is to evaluate the effect of BFRT on quadriceps strength and knee biomechanics and to identify the potential mechanism(s) of action of BFRT at the cellular and morphological levels of the quadriceps.
This will be a randomized, double-blind, placebo-controlled clinical trial.
The study will take place at the University of Kentucky and University of Texas Medical Branch.
Sixty participants between the ages of 15 to 40 years with an ACL tear will be included.
Participants will be randomly assigned to (1) physical therapy plus active BFRT (BFRT group) or (2) physical therapy plus placebo BFRT (standard of care group). Presurgical BFRT will involve sessions 3 times per week for 4 weeks, and postsurgical BFRT will involve sessions 3 times per week for 4 to 5 months.
The primary outcome measure was quadriceps strength (peak quadriceps torque, rate of torque development). Secondary outcome measures included knee biomechanics (knee extensor moment, knee flexion excursion, knee flexion angle), quadriceps muscle morphology (physiological cross-sectional area, fibrosis), and quadriceps muscle physiology (muscle fiber type, muscle fiber size, muscle pennation angle, satellite cell proliferation, fibrogenic/adipogenic progenitor cells, extracellular matrix composition).
Therapists will not be blinded.
The results of this study may contribute to an improved targeted treatment for the protracted quadriceps strength loss associated with anterior cruciate ligament injury and reconstruction.
尽管采用了最佳实践，前交叉韧带重建后，股四头肌力量缺陷仍常常持续多年。血流限制训练（BFRT）是一种新的可能干预措施，它在患者运动时将加压袖带应用于大腿近端，部分阻断血液流动，从而使患者能够在降低的负荷下进行训练。这种训练被认为会产生与患者在高负荷下训练相同的效果。
评估 BFRT 对股四头肌力量和膝关节生物力学的影响，并确定 BFRT 在股四头肌的细胞和形态学水平上的潜在作用机制。
这将是一项随机、双盲、安慰剂对照的临床试验。
该研究将在肯塔基大学和德克萨斯大学医学分校进行。
将纳入年龄在 15 至 40 岁之间、有 ACL 撕裂的 60 名参与者。
参与者将随机分配到（1）物理治疗加主动 BFRT（BFRT 组）或（2）物理治疗加安慰剂 BFRT（标准护理组）。术前 BFRT 将包括每周 3 次，持续 4 周，术后 BFRT 将包括每周 3 次，持续 4 至 5 个月。
主要结局指标是股四头肌力量（峰值股四头肌扭矩，扭矩发展率）。次要结局指标包括膝关节生物力学（膝关节伸肌力矩、膝关节伸展幅度、膝关节屈曲角度）、股四头肌肌肉形态（生理横截面积、纤维化）和股四头肌肌肉生理学（肌纤维类型、肌纤维大小、肌纤维角度、卫星细胞增殖、成纤维细胞/脂肪细胞祖细胞、细胞外基质组成）。
治疗师将无法被蒙蔽。
这项研究的结果可能有助于改善与前交叉韧带损伤和重建相关的持续股四头肌力量丧失的靶向治疗。
