Blood flow restriction training in anterior cruciate ligament reconstruction: Narrative review

Blood flow restriction training (BFRT) has emerged as an effective low-load resistance method that promotes muscle strength and hypertrophy comparable to high-intensity training. This review summarizes the current evidence on its application before and after anterior cruciate ligament reconstruction, focusing on physiological mechanisms, clinical outcomes, and safety. Studies indicate that early postoperative BFRT enhances quadriceps strength, muscle hypertrophy, and functional recovery with minimal adverse events, while preoperative protocols show inconsistent results due to short duration and methodological variability. Integrating BFRT into late-stage rehabilitation and return-to-sport phases, particularly with plyometric and sport-specific exercises, may improve muscle symmetry, psychological readiness, and performance outcomes. When applied appropriately under supervision using individualized occlusion pressures (40%–80% artery occlusion pressure; 20%–50% one-repetition maximum), BFRT is safe and beneficial for athletes unable to tolerate high mechanical loads.