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Emerging evidence suggests that bracing may support ligament healing, yet immobilisation can trigger muscle atrophy. This study protocol investigates whether adding blood flow restriction (BFR) training to conservative ACL rehabilitation improves outcomes. 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Journal of Orthopaedic Surgery and Research (2026) 21:10  \n[https://doi.org/10.1186/s13018-025-06285-y](https://doi.org/10.1186/s13018-025-06285-y)  \nJournal of Orthopaedic Surgery and Research  \nSTUDY PROTOCOL Open Access  \nConservative treatment using blood   \nflow restriction and brace in individuals with complete anterior cruciate ligament rupture: protocol for a randomised clinical trial  \nAlexios Pitsill ides 1*, Antonis Constantinou 1, Christos Karagiannis 1 and Konstantinos Giannakou 1  \nAbstract  \nBackground Inadequate long-term outcomes are common following both surgical and non-surgical management of anterior cruciate ligament (ACL) rupture. Emerging evidence suggests that a bracing protocol may facilitate ligamentous healing; however, a period of immobilisation can induce muscle atrophy. This study aims to investigate the potential benefits of adding blood flow restriction (BFR) training to the conservative treatment of ACL rehabilitation.  \nMethods This is a double-blinded, two-arm randomised clinical trial. Participants in the intervention group will follow an exercise protocol using BFR training, while participants in the control group will follow the same protocol with sham-BFR. Both groups will follow the same bracing protocol. Individuals aged between 18 and 40 years with an acute or subacute complete ACL tear confirmed by imaging will be eligible to participate.  \nDiscussion Emerging evidence suggests that a conservative period of joint immobil isation, in which positioning the knee reduces the distance between the two torn ligament ends, may promote ACL healing after a complete rupture. However, the use of a brace can result in muscle atrophy. BFR exercises may play an important role during this period of immobilisation and restricted movement. Positive results of exercise under BFR, in combination with a brace, could serve as an alternative treatment for participants with acute or subacute complete ACL tears, potentially reducing recovery time or even avoiding surgery.  \nTrial registration This protocol was approved by the Cyprus National Bioethics Committee (ΕΕΒΚ/ΕΠ/2024/70) and [registered on ClinicalTrials.gov](registered on ClinicalTrials.gov) (Registration number: NCT06727344) .  \nKeywords Anterior cruciate ligament, Complete rupture, Blood flow restriction training, Ligamental healing, Bracing protocol, Clinical trial  \n*Correspondence: Alexios Pitsill ides  \n[A.Pitsill ides@external.euc.ac.cy](A.Pitsill ides@external.euc.ac.cy)  \n1Department of Health Sciences, School of Sciences, European University Cyprus, 6, Diogenes 2404 Engomi, P. O. Box: 22006, 1516 Nicosia, Cyprus  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/.  \nPitsillides et al. Journal of Orthopaedic Surgery and Research (2026) 21:10 Page 2 of 11  \nBackground  \nAnterior cruciate ligament (ACL) reconstruction is a widely practised surgical intervention for ACL ruptures, particularly among athletes. The ACL","cbCait2qBQd3KssQ","https://ap.wps.com/l/cbCait2qBQd3KssQ","pdf",1681941,11,"English","# Abstract\n## Background\n## Methods\n## Discussion\n## Trial registration\n## Keywords\n# Background\n## ACL surgery outcomes and limitations\n## Rationale for conservative management and immobilisation","[{\"question\":\"What problem does this trial aim to address for complete ACL rupture?\",\"answer\":\"Long-term outcomes after both surgical and non-surgical management of complete ACL rupture are often inadequate. The protocol targets whether conservative rehabilitation can be improved while avoiding muscle atrophy from immobilisation.\"},{\"question\":\"How are participants assigned and what interventions are compared?\",\"answer\":\"This double-blinded, two-arm randomised clinical trial compares an intervention group using BFR training with a control group using sham-BFR. Both groups follow the same bracing protocol.\"},{\"question\":\"Who is eligible to participate?\",\"answer\":\"Adults aged 18 to 40 with an acute or subacute complete ACL tear confirmed by imaging are eligible.\"}]","Conservative treatment using blood flow restriction and brace in individuals with complete anterior cruciate ligament rupture - protocol for a randomised clinical trial | PDF",1790736349,28]