Another BFR Success Story: The Crucial Role of BFR after a Second Meniscal Repair within ACL Rehab (Part 1)

There are some things that we can all agree on, regardless of our cultures or nationalities…higher taxes are a bad thing, more muscle and less fat is a good thing, and Cristiano Ronaldo’s hair is made of some alien substance that remains perfectly styled even after playing an entire game with multiple headers.  Today, we are talking about an ACL rupture and no matter if you call it soccer, football, or something completely different, we can all agree that a torn ACL is a bad thing.

Today, we are diving into the case of a 25-year-old Dutch recreational soccer player who suffered an ACL rupture in June 2019.  Let’s call him Mike.  After conservative rehab, Mike ended up undergoing a meniscal repair with ACL reconstruction through bone-patellar tendon-bone (BPTB) graft in August 2020. 

After five months of grueling recovery, Mike remained with persistent pain and limited extension range of motion. The orthopedic surgeon decided to perform a second meniscal repair in June 2021. 

As a sports physical therapist, my main concern was the inevitable loss of muscle mass and strength, which we had worked so hard to build up over the past few months.  I thought to myself, “What can I possibly do to limit atrophy and strength loss while Mike was unable to tolerate heavy loads?” It was at this moment that blood flow restriction training was introduced. 

We started to apply BFRT 3x/week starting one week after surgery. We used the classic 30, 15, 15, 15 protocol with leg extensions at 50% LOP.  After two weeks, we progressed cuff pressure to 80% LOP and pushed closer to failure on the last set. After one week, Mike’s pain went from 4/10 to 0/10 and there was no measurable effusion. We also saw improvements in knee extension range of motion as well as greater muscle mass at two months post-op than one day before surgery (44cm to 47.5 at 10cm above the patella and from 54.2 to 57 at 20cm above the patella, with a Limb Symmetry Index within 5% for both). We eventually stopped BFR and Mike was able to tolerate strength training at 80% 1RM.  As we say at The BFR Pros, BFR is a bridge to heavy training.

What a great way to end Mike’s incredible story!  Let’s saddle up and ride off into the sunset.  Hold on cowboy.  Unfortunately, Mike’s story does not end there.  Believe it or not, Mike will be faced with yet another challenging set back to his recovery.  You are NOT going to want to miss the rest of Mike’s awesome story.  Be sure to check out Part 2 coming soon!

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****Remember, the use of BFR training should not be based solely on a success story.  The decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice.