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Impact of Tourniquet Use on Arthroscopic Anterior Cruciate Ligament Reconstruction: A Systematic Review and
Peyman Mirghaderi1,2, Negar Ahmadi2, Alireza Azarboo2
1Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Washington.
Background:
Anterior cruciate ligament tears are a common injury that is often treated with arthroscopic anterior cruciate ligament reconstruction (ACLR). This meta-analysis investigates the impact of tourniquet use on ACLR and the outcomes of this procedure.
Methods:
Searches were conducted across 4 databases: Embase, PubMed, Scopus, and the Web of Science. The quality of the included studies was assessed using the Consolidated Standards Of Reporting Trials (CONSORT) 2010 checklist. A meta-analysis was performed to compare the outcomes between patients who underwent ACLR with versus without a tourniquet.
Results:
Eight studies were eligible for systematic review; of these, 6 were eligible for meta-analysis. The CONSORT scores for the studies ranged from 22 to 37. No significant differences were found between the groups in terms of intraoperative blood loss (standardized mean difference, with versus without a tourniquet [SMD], -2.15; 95% confidence interval [CI]: -5.87, 1.58; I 2 = 99%), surgery time (SMD, -0.57; 95% CI: -1.32, 0.18; I 2 = 94%), or Lysholm knee scores after 1 year (SMD, -0.06; 95% CI: -0.33, 0.21; I 2 = 0%). The quality of the arthroscopic visual field varied across the studies. Postoperative pain levels were significantly higher in the tourniquet group (SMD 6-hour follow-up , 1.77; 95% CI: 0.07, 3.47; I 2 = 93%), although morphine consumption did not differ significantly between the groups (SMD, 0.25; 95% CI: -0.83, 1.33; I 2 = 93%). The no-tourniquet group had significantly greater thigh (SMD, -0.46; 95% CI: -0.79, -0.14; I 2 = 36%) and calf (SMD, -0.26; 95% CI: -0.49, -0.03; I 2 = 70%) circumferences postoperatively.
Conclusions:
Tourniquet use during ACLR did not significantly impact intraoperative blood loss, hemoglobin levels, or surgery time but was associated with increased postoperative pain. The use of epinephrine solution may be a viable alternative to the use of a tourniquet to improve visualization.
Level Of Evidence:
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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