Summary

Tourniquet use during ACL reconstruction does not appear to have negative long-term consequences.

Abstract

Purpose

The effects of tourniquet use during arthroscopic anterior cruciate ligament (ACL)
reconstruction are unclear; thus, this study aims to evaluate the effects of tourniquet use during
arthroscopic ACL reconstruction on intraoperative and post-operative parameters.

Methods

A systematic review using PubMed, EMBASE, and Cochrane Database of Systematic
Reviews was conducted following the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. Randomized controlled trials and non-randomized studies that
evaluated intraoperative and postoperative effects of tourniquet usage during arthroscopic ACL
reconstruction were included. Outcomes evaluated included intraoperative visualization, pain,
quadricep strength, thigh girth, calf girth, and operative time.

Results

Eight studies with 502 total patients were included in this review. There were 253 total
patients in the tourniquet (T) group and 249 in the non-tourniquet (NT) group. Post-operative
blood loss was higher in the T group compared to the NT (p<0.05). Of the studies measuring
post-operative analgesic usage, two studies reported significant increases in usage within the T
group (p<0.05), while two studies listed no significant differences between groups. In studies
measuring post-operative pain levels, pain was not significantly increased in either group two
days post-operation; however, two studies reported an increase in pain in the T group within the
immediate post-operative period (p<0.05). Although three studies indicated an initial decrease in
quadriceps strength within the T group following surgery (p<0.05), overall findings consistently demonstrated a recovery of quadriceps strength within a few weeks. Similarly, there were no
significant differences in leg girth reported. Decreased operative time associated with tourniquet use were consistently reported (p<0.05).

Conclusions

Tourniquet use during ACL reconstruction does not appear to have negative long-term consequences. Tourniquet use was associated with increased quadriceps atrophy and pain in the immediate post-operative period, but such effects do not persist chronically.