Blood Flow Restriction Training Prior to and After Anterior Cruciate Ligament Reconstruction: A Scoping Review

Background: Anterior cruciate ligament injuries often lead to muscle atrophy and prolonged recovery following anterior cruciate ligament reconstruction (ACLR). Blood flow restriction (BFR) has emerged as a strategy to optimize neuromuscular adaptations with lower loads, potentially enhancing rehabilitation outcomes in both preoperative and postoperative phases. This review aims to comprehensively evaluate the comparative effectiveness of BFR applied during resistance and endurance exercises versus non-BFR protocols, both before and after ACLR, while also examining key training parameters and BFR protocols to guide further research and clinical practice. Methods: A comprehensive literature search was conducted across multiple databases, including WoS, PEDro, Scopus, PUBMED (MEDLINE), SportDiscus, and the Cochrane Library, covering publications from inception to 24 September 2025. Studies eligible for inclusion were randomized controlled trials and quasi-randomized controlled trials that compared BFR interventions with non-BFR training in patients undergoing ACLR. Data synthesis followed the recommendations of the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The PEDro and CERT scales were used to assess the methodological quality of the included studies. Detailed training parameters and cuff specifications were extracted and are summarized in tables. Results: In total, 15 of the initial 441 articles identified met the eligibility criteria and were included in the final analysis, comprising a sample of 417 patients. Outcomes were categorized into six areas: body composition, neuromuscular responses and adaptations, self-report questionnaires, functional measures, muscle physiology and biomarkers, and return to activity. Five articles focused on preoperative interventions, nine focused on postoperative interventions, and one addressed both phases. Conclusions: This review suggests that BFR resistance training is an effective tool in the preoperative and postoperative phases of ACLR. Additionally, it can help improve muscle size, strength, functional measurements, body composition, muscle blood flow, and subjective perceptions.