Summary
Tourniquet use during ACL reconstruction does not improve intraoperative visualization and does not reduce surgical time but leads to higher postoperative pain with a risk of well-known tourniquet-related complications.
Abstract
Purpose
To examine the effect of tourniquet use in arthroscopic anterior cruciate ligament reconstruction in terms of (1) intraoperative visualization, (2) surgical time, (3) consumption of sterile saline, and (4) postoperative pain.
Methods
In this prospective randomized clinical trial, patients were assigned to tourniquet inflation (tourniquet-up) or no tourniquet (using an arthroscopic pump and local injection with mepivacaine and adrenaline) groups. Primary outcomes were intraoperative visualization (divided into 7 different surgical moments: supra-patellar; medial compartment; lateral compartment; central pivot; femoral tunnel; tibial tunnel; graft passage) assigning a score from 0 to 10 (0=no visibility; 10=clear and perfect display) surgical time (from the moment of skin incision to suture) and consumption of sterile saline. The secondary aim was postoperative pain (24 hours after surgery) measured with the Visual Analog Scale (VAS) for Pain. A t test or a Wilcoxon-Mann?Whitney test was performed to assess mean differences between groups, while differences between categories were assessed with the chi-squared or Fisher’s exact test. To assess whether groups differed in terms of VAS, saline solution, surgical time and visualization, t tests or nonparametric Wilcoxon-Mann?Whitney tests were performed.
Results
A total of 71 patients were included in the No Tourniquet group, and 75 were included in the Tourniquet group, with mean ages of 26.73 ±8.05 years and 26.95 ±10.11, respectively (p=0.88). No difference was found between gender and side. In the no tourniquet group, there were 37 concomitant meniscal lesions treated, while in the tourniquet group, there were 38 (p=0.99). For No Tourniquet and Tourniquet the mean surgical times were respectively 51.07 ±6.90 minutes and 50.03 ±7.62 minutes (p=0.325), while saline consumption was respectively 6.17 ±1.18 liter versus 5.89 ±1.23 liter (p=0.217). Both groups reached an optimal visualization with a sum of all surgical steps of 65.49 ±1.86 for the no tourniquet group and 65.39 ±1.88 for the tourniquet group (p=0.732). Postoperative pain was significantly lower in the No tourniquet group (VAS: 2.82 ±1.33 versus 5.80 ±1.22).
Conclusions
Tourniquet use during ACL reconstruction does not improve intraoperative visualization and does not reduce surgical time but leads to higher postoperative pain with a risk of well-known tourniquet-related complications.