This randomized clinical trial is designed to compare three different rehabilitation methods for patients who have undergone anterior cruciate ligament (ACL) reconstruction. The study aims to determine whether low-load blood flow restriction training (LL-BFRt) is more effective than high-load eccentric training (HL-Et) and a sham LL-BFRt in improving three key areas: patellar position, muscle morphology, and leg function. Study Design and Interventions Participants will be randomly assigned to one of the three intervention groups. All groups will perform eccentric exercises, including single leg squats, single leg deadlifts, lateral step downs, and single leg calf raises. The key differences lie in the load and the use of blood flow restriction: LL-BFRt Group: Participants will train at 30% of their repetition maximum (RM) while a cuff restricts blood flow to 70% of their artery occlusion pressure (AOP). HL-Et Group: Participants will train at a higher intensity, using 70% of their repetition maximum (RM), with no blood flow restriction. Sham LL-BFRt Group: Participants will perform the same exercises as the LL-BFRt group at 30% of their RM, but the cuff will not be inflated to a pressure that restricts blood flow. After the training period, the researchers will compare the outcomes across all three groups to see which method leads to the most significant improvements in patella position, muscle morphology, and leg function.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
The participants' two legs will be subjected to 70% arterial occlusion pressure when the physical therapist applies the BFR cuffs. After that, participants will be required to complete eccentric exercises with a maximum repetition count of 30%, such as single leg squat, single leg deadlift, lateral step down, dan single leg calf raise.
The participants' two legs will be subjected to 10% arterial occlusion pressure when the physical therapist applies the BFR cuffs. After that, participants will be required to complete eccentric exercises with a maximum repetition count of 30%, such as single leg squat, single leg deadlift, lateral step down, dan single leg calf raise.
The physical therapist will instruct the participants to complete eccentric exercises at a maximum of 70% repetitions, such as single leg squat, single leg deadlift, lateral step down, dan single leg calf raise.
Physical therapy laboratory, College of Medicine, Universitas Udayana and ROM Physiotherapy Private Clinic Denpasar
Denpasar, Bali, Indonesia
Patella position
Using a musculoskeletal ultrasonography, researchers will determine the patella position.
Time frame: 8 weeks
Muscle cross-sectional area
Using a musculoskeletal ultrasonography, researchers will determine the cross-sectional area of vastus medial obliques muscle and hamstring muscles.
Time frame: 8 weeks
Vastus medial obliques fiber angle
Using a musculoskeletal ultrasonography, researchers will determine the vastus medial obliques fiber angle.
Time frame: 8 weeks
Quadriceps strength
Using a hand-held dynamometer, researchers will determine the isometric quadriceps muscle.
Time frame: 8 weeks
Dynamic balance
Using a modified star excursion balance test, researchers will determine the distance of three positions of legs reaching, including forward, posteromedial, and posterolateral.
Time frame: 8 weeks
Leg function
Using KOOS questionnaires will determine the subjective score of the patient's leg function.
Time frame: 8 weeks
Anterior knee pain
Using the Kujala questionnaire will determine the subjective score of the patient's knee pain levels.
Time frame: 8 weeks
Incidence of anterior cruciate ligament reinjury
Researchers will determine the incidence of anterior cruciate ligament reinjury with the physical examination of Lachman's test.
Time frame: 1 year
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