Optimizing Preoperative and Postoperative Blood Flow Restriction Protocols for Isolated ACL Reconstruction: An International Delphi Study.

Introduction: Blood Flow Restriction (BFR) combined with therapeutic exercise has proven to be an effective tool for preserving muscle mass and optimizing function in patients with anterior cruciate ligament (ACL) injuries. However, there is a lack of standardization in its clinical application, particularly during the preoperative and postoperative phases of ACL reconstruction. In response to this need, the development of an expert consensus is proposed to define specific and safe protocols for BFR use in this context. Objective: To identify the criteria used in the application of blood flow restriction (BFR) protocols combined with exercise during the preoperative and postoperative phases in patients undergoing ACL reconstruction, with the ultimate goal of establishing clear guidelines regarding its application, progression, and frequency. Methodology: A three-round Delphi study will be conducted using online surveys. The questionnaire will be structured into six thematic blocks: (1) General guidelines for BFR application, (2) Specific protocols and considerations, (3) Frequency of BFR application, (4) Progression of protocols, (5) Preoperative ACL phase, and (6) Postoperative ACL phase. Over 30 experts—including researchers and clinicians with recognized experience in ACL rehabilitation and Blood Flow Restriction—will participate in the validation process. Experts will evaluate each item using Likert scales and provide qualitative feedback to refine content across successive rounds. Consensus will be defined based on pre-established agreement thresholds. The REDCap platform will be used to manage data collection, monitoring, and analysis. Descriptive analysis will be conducted to assess the level of consensus achieved and to identify items requiring modification or reformulation across rounds.