Six randomized controlled trials including 228 patients with knee osteoarthritis were included in this systematic review and meta-analysis comparing blood flow restriction training (BFRT) versus traditional resistance training. Pooled outcomes of interest included pain, muscle strength, functional performance, self-reported function, muscle size, and adverse events. BFRT did not significantly improve pain, muscle strength, functional performance, or self-reported function compared to resistance training. However, BFRT was associated with reduced risk of adverse events and significantly improved muscle size compared to low-load resistance training. These findings suggest that while BFRT may not improve symptomatic outcomes over resistance training, it may be a safer and viable alternative for increasing muscle size in knee OA patients who cannot tolerate higher training loads.