Twelve randomized controlled trials including 642 middle‑aged/older patients with knee osteoarthritis or total knee arthroplasty were included in this systematic review and meta‑analysis comparing low‑load Blood Flow Restriction (BFR) training versus low‑load control and high‑load resistance training. Pooled outcomes of interest included muscle strength, pain, and postoperative strength following preoperative BFR. Compared with low‑load control, BFR improved strength without reducing pain. Versus high‑load training, BFR achieved similar strength and pain. Preoperative BFR increased postoperative strength but not postoperative pain. Overall, BFR is a viable low‑load option to restore strength in knee rehabilitation, especially for prehabilitation, though analgesic benefits appear limited.