Another BFR Success Story: The Crucial Role of BFR after a Second Meniscal Repair within ACL Rehab (Part 2)

Aaaaaaand we’re back, ladies and gentlemen!  Welcome to Part 2 of this incredible recovery story of our friend, Mike.  Just to recap from Part 1, Mike is a 25-year-old male who suffered an ACL and meniscus tear in a soccer game.  Mike initially tried to treat his knee conservatively with physical therapy, however ended up undergoing surgery.  After months of rehabilitation post-operatively, Mike ended up undergoing yet another meniscus repair surgery to address some persistent pain.  BFR was implemented at this time to preserve muscle mass and strength while Mike was unable to tolerate heavy loads.

After five months of grueling rehab, Mike made a misstep in a pond and although he did not cause structural damage, he did develop significant pain on the lateral side of his knee.  Mike received a series of corticosteroid injections and was restricted from performing high load strength training for six weeks. 

We decided to use BFR training again with the same application parameters as the first time.  This time around, we started with 3 sets of 1-minute isometric leg extensions. After two weeks, we progressed to active leg extensions for about 75 reps. As always, BFR training acted as a bridge to heavy lifting and we eventually reintroduced jumping and running.  Using an isokinetic strength test with a Biodex, we found impressive gains in maximal strength, considering we had not started maximal strength training yet.

For maximal strength, Mike had a Limb Symmetry Index (LSI) of 8.1% for the quadriceps and 5.1% for the hamstrings. For strength endurance, Mike’s LSI was 11.0% for the quadriceps and 14.0% (in favor of operated leg) for hamstrings. Peak torque for the quadriceps was 227.5Nm, as opposed to 117.7Nm at four months post op and 170.1Nm at six months post op (one day before second meniscal repair). 

Mike’s peak torque at 60°/sec increased by 57.4 Nm without performing maximal strength training!  Think BFR training had anything to do with that? I’m not a gambling man, but I’d bet on, “Yes!”

So what happened to Mike in the end?  Well, he saddled up his horse, pointed it toward the sunset, and rode off…which was cool for about 4 minutes until he realized how uncomfortable and bumpy riding a horse actually is.  In December 2021, Mike was running for 30 minutes, performing on-field rehab, and participating in jump training, maximal strength training, and velocity based training. After 2 years of hard work, Mike made his first minutes again on the field!

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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.