OBJECTIVES: The effectiveness of low-load blood flow restriction training (LL-BFRT) in alleviating symptoms in patients with knee osteoarthritis (KOA) remains inconclusive. This systematic review and meta-analysis aim to comprehensively assess the effects of LL-BFRT compared to conventional resistance training on pain, muscle strength, and functional capacity in individuals with KOA. DATA SOURCES: PubMed, Embase, Web of Science, EBSCO, Scopus, and Cochrane trails were searched. STUDY SELECTION: We included randomized controlled trials involving patients with KOA, in which the intervention group underwent LL-BFRT. DATA EXTRACTION: Literature quality and risk of bias were assessed using the Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk-of-Bias Tool (ROB 2). Data were extracted using a predefined table, including outcomes such as pain, quadriceps muscle strength, 30-s sit-to-stand test (30STS) and Timed Up and Go test (TUG). RESULT: Ten studies were included in the meta-analysis. The pooled results indicated that, compared to conventional resistance training, LL-BFRT significantly improved knee joint pain (SMD 0.25, 95% CI 0.02 to 0.48, p = 0.03), increased quadriceps muscle strength (SMD 0.46, 95% CI 0.04 to 0.88, p = 0.03), and enhanced performance on the 30s sit-to-stand test (30STS) (WMD 1.71, 95% CI 0.30 to 3.11, p = 0.02). However, no significant difference was observed in the improvement of the Timed Up and Go test (TUG) (WMD -0.13, 95% CI -0.51 to 0.24, p = 0.49). Subgroup analysis revealed that interventions with an occlusion pressure > 100 mmHg and a duration <= 6 weeks had a significant impact on pain relief, quadriceps muscle strength, and the 30STS performance. For patients with KOA aged > 65 years, LL-BFRT was more effective in alleviating pain, while for patients aged <= 65 years, it demonstrated more significant improvements in quadriceps strength and 30STS performance. CONCLUSION: Limited evidence suggests that LL-BFRT may be more effective than conventional resistance training in improving pain, quadriceps muscle strength, and 30STS performance in patients with KOA, while exhibiting a comparable effect on TUG test. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42024603542.

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