BACKGROUND: After anterior cruciate ligament (ACL) reconstruction (ACLR), the function and strength of the quadriceps muscle are essential for a successful recovery. Low-load blood flow restriction training (LL-BFRT) is believed to reduce muscle atrophy and restore muscle function. PURPOSE: To systematically analyze the evidence on the effectiveness of LL-BFRT in early rehabilitation after ACLR. STUDY DESIGN: Systematic review; Level of evidence, 1. METHODS: A systematic review and meta-analysis were conducted consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Comprehensive literature searches were performed in several electronic databases -- including Cochrane Library (trials), PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database, and Sinomed -- from inception to October 1, 2023. Included were randomized controlled trials in Chinese and English comparing LL-BFRT within 6 weeks after ACLR with conventional rehabilitation training. Bias risk was assessed using the Cochrane Risk-of-Bias 2 tool. The outcomes measured were quadriceps muscle size, knee joint functional scores, balance function, and complications. The effects of LL-BFRT versus conventional rehabilitation were analyzed using standardized mean differences (SMDs) or weighted mean differences (WMDs). RESULTS: A total of 362 studies were initially identified, and 8 were included for analysis. LL-BFRT was significantly more effective in improving quadriceps muscle volume (SMD 0.37 (95% CI 0.08 to 0.66); p = 0.01) and Lysholm scores (SMD 0.74 (95% CI 0.43 to 1.05); p < 0.0001) compared with conventional rehabilitation training. However, no significant improvements were observed in the 3 directions of the Y-balance test: anterior (WMD 0.55 (95% CI -6.37 to 7.46); p = 0.88), posteromedial (WMD -2.24 (95% CI -8.76 to 4.29); p = 0.50), and posterolateral (WMD 0.02 (95% CI -13 to 13.03); p = 1.0). No complications were reported in any of the included studies. CONCLUSION: The results of this meta-analysis suggested that LL-BFRT within 6 weeks after ACLR has a more pronounced effect on increasing quadriceps muscle volume and improving Lysholm scores compared with conventional rehabilitation training, with no apparent complications.

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