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Anterior Cruciate Ligament (ACL) TearNCT03364647

The Effect of Various Strength Training Protocols in ACL Reconstructed Participants

A study testing Arm A - blood flow restriction training in people with Anterior Cruciate Ligament (ACL) Tear and Physical Therapy, run by Brian W. Noehren at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of the study is to determine how two different blood flow restriction training programs used in conjunction with standard rehabilitation affect leg strength. By doing this study, the investigator hopes to learn if one program improves strength and function more than the other. Read more about this study

Who is it for?
Ages 15 to 40 years
What is being tested?
Arm A - blood flow restriction training
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
55 participants
Where
2 sitesUnited States
Study dates
21 Aug 2017to 6 Oct 2023
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 15 to 40 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • ACL tear and no previous ACL reconstruction on either the involved or other limb

Who cannot join

  • Previous surgeries or conditions that might affect gait
  • Any current condition other than ACL or meniscus injury which might affect gait
  • Unable to provided informed consent
  • Diabetic or have uncontrolled hypertension
  • Have recent inflammation, bleeding disorders, active bleeding or infection within the lower limbs.
  • Allergic to Betadine or Xylocaine HCL.
Show all 13Show fewer
  • Taking warfarin/Coumadin, clopidogrel/Plavix, Rivaroxaban/Xarelto, Dabigatran/Pradaxa that may cause excess bleeding.
  • Any implanted medical device
  • A history of deep vein thrombosis, have a family history of deep vein thrombosis, or varicose veins
  • Spinal fusion
  • Inability able to attend regular physical therapy or study visits
  • Injury occurring more than ten weeks prior to study enrollment
  • Not skeletally mature (growth plates not closed)

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • University of Kentucky Orthopaedics and Sports Medicine Center

    Lexington, Kentucky, 40504

  • University of Kentucky BioMotion Laboratory, 725 Rose Street

    Lexington, Kentucky, 40536-0082

Other trials in United States

About this study

The purpose of the study is to determine how two different blood flow restriction training programs used in conjunction with standard rehabilitation affect leg strength. By doing this study, the investigator hopes to learn if one program improves strength and function more than the other. The investigator also hope to learn how the training affects the properties of muscle in participants who will or have had anterior cruciate ligament (ACL) reconstruction. These results will help define how the training programs are working.

There will be no charge to the participant for their physical therapy visits as long as they are part of the study

Read more

The initial visit and follow up assessment at the end of the training will each take up to 6 hours (2 hours for MRI, 2 muscle biopsy, 2 for muscle strength, movement mechanics and questionaires).

The physical therapy visits will range from 60-120 minutes depending on the participant's stage of recovery and the activities to engage in. Training sessions will be held 3 days a week for approximately 4 weeks before surgery and up to 24 weeks after surgery. There will be a total of 4 additional study visits over a 7 month period. The first visit will be used to capture baseline conditions of their knee and thigh muscles (muscle biopsy, MRI, strength). The second visit will occur right before surgery to assess changes during prehabilitation (strength and walking mechanics). The third visit will occur 4-5 months after surgery and will be a complete reevaluation of their thigh muscle and knee function (muscle biopsy, MRI, strength, gait). The last visit will occur 6-7 months after surgery and will involve an assessment of their thigh muscle strength, walking, and jumping form.

The muscle biopsy and magnetic resonance imaging portion of the study will occur in the outpatient unit of the Center for Clinical and Translational Science at the UK Medical Center and the MRI center located on the medical center campus. The muscle biopsy will take an additional 15 minutes and the MRI up to two hours (1 hour per leg). It can take up to 4 hours total to complete both procedures. The investigator will accommodate participant preference for scheduling.

Read the detailed description

The following procedures may be performed.

Training sessions: Participants will be randomly assigned one of two groups. Assignments to which group are determined by random assignment based upon participant's number. One group will receive standard of care and the other will receive standard of care plus blood flow restriction training.

The air bands will then be placed on the participant's thighs and they will be doing a standardized exercise program that will vary depending on the stage of rehabilitation they are in and as determined by the study personnel. Participants will also complete a standardized course of physical therapy. Activities in physical therapy may include ice over the knee, range of motion exercises to maintain hip strength and gait training exercises as needed and as the participant's impairments dictate. The investigator will also provide an educational program at regular intervals on the injury and recovery.

Quadriceps strength: Participants will sit in a seated position and a stabilizing strap will be placed around the thigh. A second strap will be placed around the bottom of their lower leg and attached to the isokinetic dynamometer (a muscle strength testing device) which will control movements and apply force at several different speeds and in a isometric mode.

Motion Analysis: Motion analysis will provide a means for evaluating motion of the participant's hip, knee and ankle joints during walking and jogging on the treadmill. Participants will have reflective markers placed on certain landmarks of their legs and lower back to allow the motion analysis system to record their trunk, hip, knee, and ankle movements. Markers will be applied with sticky tape to the skin and if necessary, athletic tape to limit marker movement during activities. A stationary trial will be collected to help the researcher identify anatomical landmarks. Motion data will be collected for 10 seconds every minute. Participants will perform a series of jumps on both legs and on a single leg. In addition participants will be asked to go up and down step.

Treadmill Activity: Participants may walk on the treadmill as long as necessary to feel comfortable with it. Once ready, participants will walk at a self-selected warm up pace for 5 minutes. The investigator will then gradually increase the speed 1.5 m/s for 2 minutes each. The speed of the treadmill will then be increased gradually to a self-selected comfortable jogging\running pace for 2 minutes. Participants may request to stop at any time.

Muscle Biopsy: A small piece of muscle tissue will be removed from both of thighs. The muscle tissue will be taken from the outside of your thigh and will be taken about one hand width above your knee. A 1 inch by 1 inch portion of hair will possibly need to be shaved if necessary. The area of thigh will be numbed and a small ¼ inch incision will be made in the skin. A needle will then be briefly (lasting just a couple of seconds) inserted into the muscle to remove a .005 ounce piece of muscle (about the size of a pencil eraser). The incision will be pulled closed with a band-aid after the site is cleaned with an alcohol preparation and the participant's leg will be wrapped snugly with an elastic bandage. The procedure will last approximately 15 minutes. The tissue samples will be used in the analysis process. In addition, standard venipuncture methods will be used to collect one 7.5 mL tube of blood to be used for analysis.

Magnetic Resonance Imaging \& Spectroscopy Center: Participants will be asked to complete a medical screening questionnaire that will ask specific questions about their health and medical history. This information will be used to determine eligibility to participate in the study. At this time, the procedures and risks involved in participating in the research study will be explained to the individual. Participants will also fill out a questionnaire asking whether they have any metal in their body as well as any other medical conditions that may need to be considered before they enter the MRI scanner. The metal screening questionnaire will be reviewed by the individual operating the scanner and if any risks are identified, the participant may not be able to participate.

Participants will be taken to the MRI scanner by the experimenter. Participants will be asked to remove all jewelry, body piercings, hair accessories, belts, wallets, credit cards, and loose change and leave these items with the experimenter. Participants will then be instructed about specific MRI procedures.

The magnetic resonance scanning will take approximately 60 minutes per leg. Participants will be asked to lie still during the scanning.

Being tested
Arm A - blood flow restriction training, Arm B - standard of care
Medical subject headings
Lacerations

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Arm A - blood flow restriction trainingOther

    Group receive standard of care plus blood flow restriction training

  • Arm B - standard of careOther

    Group will receive standard of care plus a sham version of blood flow restriction training

Study groups in NCT03364647
Study groupRoleWhat they receive
Arm A - Blood flow restriction trainingExperimentalGroup will use blood flow restriction training and standard of care
Receives: Other: Arm A - blood flow restriction training
Arm B - standard of care plus shamSham comparatorGroup will receive standard of care plus a sham version of blood flow restriction training
Receives: Other: Arm B - standard of care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Measure Change in Isometric Peak Torque Quadriceps Strength

    Assessed with a Biodex Multi-Joint System 4 Isokinetic Dynamometer. The primary analysis may include the comparison of these observations over multiple time points, with a particular interest in whether there are between-group or within-patient differences.

    Measured: Baseline, and post-surgery (up to 5 months)

  2. Measure Change in Isokinetic Peak Torque Quadriceps Strength

    Assessed with a Biodex Multi-Joint System 4 Isokinetic Dynamometer. The primary analysis may include the comparison of these observations over multiple time points, with a particular interest in whether there are between-group or within-patient differences.

    Measured: Baseline and post-surgery (up to 5 months)

  3. Measure Change in Rate of Torque Development

    Isokinetic Dynamometer will be used. The primary analysis may include the comparison of these observations over multiple time points, with a particular interest in whether there are between-group or within-patient differences.

    Measured: Baseline and post-surgery (up to 5 months)

Secondary outcomes (4)
  1. Measure Change in Quadriceps Muscle Morphology - T1Rho Relaxation Time

    MRI will be used. Analyses may include the comparison of these observations over multiple time points, with a particular interest in whether there are between-group or within-patient differences.

    Measured: Baseline, Post-surgery (up to 5 months)

  2. Measure Change in Quadriceps Muscle Morphology - Physiological Cross-sectional Area (PCSA)

    MRI will be used. Analyses may include the comparison of these observations over multiple time points, with a particular interest in whether there are between-group or within-patient differences.

    Measured: Baseline, Post-surgery (up to 5 months)

  3. Measure Change in Knee Biomechanics - Peak Knee Flexion

    3D Motion Capture will be used. The primary analysis may include the comparison of these observations over multiple time points, with a particular interest in whether there are between-group or within-patient differences.

    Measured: Baseline and post-surgery (up to 5 months)

  4. Measure Change in Knee Biomechanics - Knee Extensor Moment (KEM)

    3D Motion Capture will be used. The primary analysis may include the comparison of these observations over multiple time points, with a particular interest in whether there are between-group or within-patient differences.

    Measured: Baseline and post-surgery (up to 5 months)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Dec 2017
  2. Study start21 Aug 2017
  3. Primary completion6 Oct 2023
  4. Study completion6 Oct 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Parallel assignment
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
55 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03364647
Sponsor's protocol ID
15-0750-F6A
Other IDs
R01AR071398
Status last verified
Jan 2025
First submitted
15 Nov 2017
Last updated
13 Jan 2025
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Erickson LN, Owen MK, Casadonte KR, Janatova T, Lucas K, Spencer K, Brightwell BD, Graham MC, White MS, Thomas NT, Latham CM, Jacobs CA, Conley CE, Thompson KL, Johnson DL, Hardy PA, Fry CS, Noehren B. The Efficacy of Blood Flow Restriction Training to Improve Quadriceps Muscle Function after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc. 2025 Feb 1;57(2):227-237. doi: 10.1249/MSS.0000000000003573. Epub 2024 Oct 1.

    PubMed 39350350
  • Erickson LN, Lucas KCH, Davis KA, Jacobs CA, Thompson KL, Hardy PA, Andersen AH, Fry CS, Noehren BW. Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength, Morphology, Physiology, and Knee Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: Protocol for a Randomized Clinical Trial. Phys Ther. 2019 Aug 1;99(8):1010-1019. doi: 10.1093/ptj/pzz062.

    PubMed 30951598

Questions about this trial

What is this clinical trial studying?

A study testing Arm A - blood flow restriction training in people with Anterior Cruciate Ligament (ACL) Tear and Physical Therapy, run by Brian W. Noehren at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 4 Dec 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Measure Change in Isometric Peak Torque Quadriceps Strength (time frame: Baseline, and post-surgery (up to 5 months)). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03364647, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jan 2025; AzTrials last refreshed its copy on 6 Nov 2026.

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