OBJECTIVE: To systematically review the clinical effect of blood flow restriction training on rehabilitation after anterior cruciate ligament reconstruction to provide a reference for clinical practice. METHODS: Databases including CNKI, WanFang, PubMed, Web of Science and EBSCO were searched to collect randomized controlled trials of blood flow restriction training in the intervention of anterior cruciate ligament reconstruction from inception to August 10, 2022. Outcomes included knee muscle strength, knee muscle mass, and knee function evaluation, all of which were continuous variables. Two reviewers independently screened the literature and extracted data. Cochrane bias risk assessment tool and Physiotherapy Evidence Database Scale were used to evaluate the bias risk of the included articles. Meta-analysis was then performed using RevMan 5.4 software. RESULTS: A total of 9 publications were included, including 226 subjects, 114 in the trial group and 112 in the control group. Meta-analysis results showed that compared with conventional resistance training, the blood flow restriction training group could significantly improve knee muscle strength (SMD 0.54, 95%CI (0.29 to 0.79), p < 0.01), muscle mass (SMD 0.26, 95%CI (0.06 to 0.46), p = 0.01) and knee joint function (SMD 1.17, 95%CI (0.53 to 1.80), p < 0.01). Subgroup analysis showed that only when the intervention time was more than 4 weeks, there were significant improvements in knee joint muscle strength (SMD 0.68, 95%CI (0.38 to 0.97), p < 0.01) and muscle mass (SMD 0.38, 95%CI (0.09 to 0.68), p = 0.01). CONCLUSIONS: Current evidence shows that blood flow restriction training can improve muscle strength and knee function in patients with anterior cruciate ligament reconstruction and reduce muscle atrophy. It is recommended that the postoperative intervention time should be more than 4 weeks to achieve better muscle strength and muscle mass improvement.

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