Optimizing ACL Recovery through Prehabilitation and Blood Flow Restriction Training during Rehabilitation: A Case Study

OBJECTIVES This study explores the application of pre-surgical rehabilitation combined with blood flow restriction (BFR) on return-to-sport (RTS) readiness in Anterior Cruciate Ligament Reconstruction (ACLR) patients. METHODS A 56-year-old active participant (S1) delayed his ACLR (5 months), during which he completed a 12-week prehabilitation program, while a 31-year-old professional footballer (S2) performed similar prehabilitations for 6 weeks prior to ACLR. The prehabilitation period focused on mobility, strengthening, and neuromuscular exercises. Post-surgery, both subjects participated in a 6-week rehabilitation (incorporating BFR training) aimed to enhance range of motion, muscle function, and functional performance. Assessments included Limb Symmetry Index (LSI) and the variables of isometric leg press (strength), Y balance test, single leg hop test (distance), and drop jump (jump height, reactive strength index). RESULTS After prehabilitation (T2), S1 improved slightly (<2% vs baseline [T1]) in strength and balance, whereas S2 showed decrements (up to -42%). After rehabilitation (12 weeks post-surgical), both subjects showed improvements (vs T2) in strength (S1: up to 29% and S2: 77%) and balance, while LSI scores (strength: 100% in S1, 97% in S2; and balance 100% in S1, 98% in S2) exceeded the 90% RTS criteria. A 24-week followup on S2 indicated further enhancements in all test parameters. CONCLUSIONS It would seem that prehabilitation combined with post-surgical rehabilitation (with BFR) may enhance the RTS process. Delayed surgery (for non-athletes) may allow a longer prehabilitation period without compromising timely RTS. Incorporating prehabilitation and BFR rehabilitation seemed favourable (returned to pre-injury “levels” and improved test measures) for ACLR patients.