Meta-analysis of blood flow restriction training to improve knee function and muscle strength in patients after anterior cruciate ligament reconstruction

doi:10.12307/2026.290

Abstract

Abstract: OBJECTIVE: Blood flow restriction training is a low-load training method designed to enhance muscle strength and promote muscle hypertrophy. Its characteristics align well with the rehabilitation needs following anterior cruciate ligament reconstruction. However, its actual efficacy remains unclear. Therefore, this study systematically evaluated the effectiveness of blood flow restriction training on knee joint rehabilitation in patients after anterior cruciate ligament reconstruction and compared the differences in knee rehabilitation outcomes between blood flow restriction training and traditional resistance training.
METHODS: By searching EBSCO, Embase, PubMed, The Cochrane Library, Web of Science English databases, CBM, CNKI, VIP, WanFang Data Chinese databases and clinical trial center database (ClinicalTrials.gov), the randomized controlled trials of knee rehabilitation after anterior cruciate ligament reconstruction were collected. The search time was from the establishment of the database to October 31, 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. The meta-analysis was performed using RevMan 5.4 software and Stata 14.0 software.
RESULTS: (1) A total of 11 studies involving 317 patients were included. (2) Meta-analysis results showed that blood flow restriction training was superior to traditional resistance rehabilitation training group in improving knee muscle strength [standardized mean difference (SMD)=0.75, 95% confidence interval (CI) (0.46, 1.04), P < 0.000 01], muscle mass around knee joint [SMD=0.48, 95% CI (0.30, 0.66), P < 0.000 01] and knee joint function [SMD=2.69, 95%CI (1.32, 4.07), P=0.000 1]. (3) Subgroup analysis showed that the muscle mass around the knee joint [SMD=0.43, 95% CI (0.23, 0.63), P < 0.000 1] was better than that of the traditional resistance rehabilitation training group when the training times were ≥ 3 times per week.
CONCLUSION: Blood flow restriction training demonstrates superior efficacy compared to traditional resistance training in improving knee muscle strength, peri-knee muscle mass, and knee function in patients following anterior cruciate ligament reconstruction. Furthermore, implementing blood flow restriction training at a frequency of three or more sessions per week during the rehabilitation period leads to more significant enhancements in peri-knee muscle mass.

Key words: blood flow restriction training, anterior cruciate ligament reconstruction, knee muscle strength, knee function, randomized controlled trial

CLC Number:

Chen Ziang, Li Qinlong, Wu Xue, Zhou Yue. Meta-analysis of blood flow restriction training to improve knee function and muscle strength in patients after anterior cruciate ligament reconstruction[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(29): 7680-7687.

Figures/Tables 8

量改善优于对照组[SMD=0.75，95%CI(0.46，1.04)，P < 0.000 01]，如图3所示。为查找此Meta分析异质性的来源，根据纳入研究的特征和设置的3个协变量进行Meta回归分析，结果见表4。在结局指标(P=0.004)干预时间(P=0.411)和干预频率(P=0.448)3个协变量中，协变量结局指标的P < 0.05。因此，干预时间和干预频率不是导致异质性的主要来源，而结局指标则可能是产生异质性的主要来源。以结局指标为分组依据对纳入研究进行亚组分析，结果见表5，血流限制训练组对膝关节等速屈伸肌力的影响优于对照组[SMD=1.01，95%CI(0.70，1.32)，P < 0.000 01]；血流限制训练组对膝关节等长屈伸肌力的影响优于对照组[SMD=0.68，95%CI(0.35，1.02)，P < 0.000 1]；血流限制训练组对膝关节屈伸1RM的影响小于对照组[SMD=-0.29，95%CI(-0.79，0.20)，P=0.25]，但该亚组仅纳入2项研究，样本量仅为64例，Meta分析结果有待进一步研究。由于此Meta分析存在异质性，故对相关文献进行逐一剔除以确定是否存在单篇文献与总效应量存在较大差异进而影响Meta分析结果。通过逐个剔除发现，当剔除某一项研究后对Meta分析的整体结果影响不大，即此Meta分析的结果较为稳定。针对该Meta分析进行发表偏倚检验，Egger’s检验结果P > 0.05(P=0.09)，但结合漏斗图发现漏斗图存在轻微不对称的情况，即此Meta分析存在轻微发表偏倚，漏斗图如图4所示。采用非参数剪补法对此Meta分析结果进行矫正，矫正结果显示血流限制训练组肌肉力量改善优于对照组[SMD=0.65，95%CI(0.33，0.96)，P < 0.000 01]。 2.4.2 血流限制训练对膝关节周围肌肉量的影响共纳入7篇文献的16项研究[20，22-23，25-28]，试验组和对照组共517例患者。固定效应模型Meta分析结果显示，血流限制训练组肌肉量改善优于对照组[SMD=0.48，95%CI(0.30，0.66)，P < 0.000 01]，如图5所示。为查找此Meta分析异质性的来源，根据纳入研究的特征和设置的3个协变量进行Meta回归分析，结果见表6。在结局指标(P=0.498)干预时间(P=0.053)和干预频率(P=0.041)3个协变量中，协变量干预频率的P < 0.05。因此，结局指标和干预时间不是导致异质性的主要来源，而干预频率则可能是产生异质性的主要来源。以干预频率为分组依据对纳入研究进行亚组分析，结果见表7，每周血流限制训练 < 3次时，血流限制训练组对膝关节周围肌肉量的影响优于对照组[SMD=0.67，95%CI(0.21，1.13)，P=0.004]；每周血流限制训练≥3次时，血流限制训练组对膝关节周围肌肉量的影响优于对照组[SMD=0.43，95%CI(0.23，0.63)，P < 0.000 1]；仅术前进行血流限制训练时，血流限制训练组对膝关节周围肌肉量的影响优于对照组[SMD=0.58，95%CI(-0.06，1.22)，P=0.070]，但影响效果不显著，且该亚组仅纳入2项研究，样本量仅为40例，Meta分析结果有待进一步研究。由于此Meta分析存在异质性，故对相关文献进行逐一剔除以确定是否存在单篇文献与总效应量存在较大差异进而影响Meta分析结果。通过逐个剔除发现，当剔除某一项研究后对Meta分析的整体结果影响不大，即此Meta分析的结果较为稳定。针对该Meta分析进行发表偏倚检验，Egger’s检验结果P > 0.05(P=0.09)，但结合漏斗图发现漏斗图存在轻微不对称的情况，即此Meta分析存在轻微发表偏倚，漏斗图如图6所示。采用非参数剪补法对此Meta分析结果进行矫正，矫正结果显示血流限制训练组肌肉量改善优于对照组[SMD=0.4，95%CI(0.23，0.57)，P < 0.000 01]。 2.4.3 血流限制训练对膝关节功能的影响共纳入5篇文献的9项研究[19，21，25-27]，试验组和对照组共245例患者。随机效应模型Meta分析结果显示，血流限制训练组膝关节功能改善优于对照组[SMD=2.69，95%CI(1.32，4.07)，P=0.000 1]，如图7所示。由于此Meta分析纳入的研究过少，故不进行Meta回归分析。产生高异质性的原因可能是由于此次所纳入的研究采用不同的膝关节"

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