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ACL reconstruction often results in an extended period of muscle atrophy and weakness. Blood flow restriction (BFR) training is a technique that has been shown to decrease muscle atrophy in a variety of populations.


The purpose of this systematic review was to analyze the research presented on the effect of blood flow restriction training on quadriceps muscle atrophy and circumference post ACL reconstruction.

Study Design:

Systematic Review


Articles were reviewed using the databases Google Scholar, PubMed, and EBSCO. Keywords included blood flow restriction training, ACL reconstruction, and quadriceps.

Inclusion criteria included:

English language, peer-reviewed journals; randomized control trials; and articles including blood flow restriction and measurement of quadriceps atrophy and circumference post ACL reconstruction. Exclusion criteria included non-English language publications; studies without a control group; and articles without sufficient data to evaluate the methodology. Four studies met the selection criteria and were assessed using the GRADE scale, which analyzes the strength of a study based on study limitations, precision, consistency, directness, and publication bias. After a GRADE designation was assigned, the following information was extracted from and compared across the studies: participant demographics, cuff used, graft used during ACL reconstruction, tool used to assess muscle atrophy, protocol used, and conclusions.


Three out of four studies showed some amount of an increase in femoral muscle cross sectional area after the use of BFR combined with low-intensity resistance training (LIRT). The strength of all four studies was moderate when assessed using the GRADE scale.


This review of the available evidence yields promising results regarding the use of BFR and LIRT in the remediation of femoral muscle atrophy after an ACL reconstruction. Further research is necessary before BFR can be recommended for use in clinical settings.

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