Posterior cruciate ligament reconstruction without tourniquet use reduces joint swelling without compromising...

The objective of this study was to determine the efficacy and safety of the employment of a tourniquet in the management of a posterior cruciate ligament reconstruction (PCLR) surgery. We hypothesized that PCLR without tourniquet use would reduce postoperative joint swelling and tourniquet-related complications while maintaining comparable surgical outcomes. We retrospectively reviewed 108 consecutive patients who underwent PCLR surgery between March 2016 and July 2022. Exclusion criteria included osteoarthritis, meniscus injury requiring repair, history of peripheral neuropathy, pregnancy, lumbar radiculopathy, or prior knee surgery on the affected or contralateral knee. Patients were categorized into tourniquet and non-tourniquet groups according to their surgery dates. The outcomes were evaluated by quantifying pain levels using the visual analog scale (VAS) and assessing the range of motion. Duration of operation, arthroscopic visibility, complications, consumption of analgesic, and total bleeding from suction and drainage were recorded. Of the 108 patients, 55 patients received PCLR with the tourniquet between March 2016 and October 2019, and 53 patients received PCLR without a tourniquet between November 2019 and July 2022. No significant difference was found in sex, age, or body mass index (BMI). There was no significant difference between the two groups with respect to intraoperatively arthroscopic visualization, operation time, total bleeding, pain score, consumption of analgesic, and range of motion. Both groups exhibited no instances of infection, wound complication, or venous thromboembolism (VTE). The rate of joint swelling was significantly higher in the tourniquet group than in the non-tourniquet group (p = 0.01). The tourniquet group also experienced a few instances of bruising and blister in the mid-thigh, while none occurred in the non-tourniquet group. Given the comparable outcomes in terms of arthroscopic visualization, operation time, bleeding, pain, function, and less joint swelling, we advocate discontinuing routine tourniquet use in PCL reconstruction. This approach significantly reduces swelling and local complications while maintaining surgical efficacy, aligning with modern minimally invasive principles.