Tourniquet use in arthroscopic anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomised controlled trials

Abstract

Background: To assess the effects of tourniquet use in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery.

Methods: We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) that compared surgical outcomes following tourniquet use against non-tourniquet use during ACL reconstruction surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for relevant RCTs. We used the Cochrane Collaboration's tool to assess the risk of bias of included RCTs, and performed a random-effects meta-analysis in calculating the pooled risk estimates. The primary outcomes was postoperative pain measured by visual analogue scale, verbal rating scale, or required morphine dose. The secondary outcomes were blood loss in drainage, operative time, muscle strength, and calf and thigh girth.

Results: We included 5 RCTs with 226 participants (116 in the tourniquet group and 110 in the non-tourniquet group). Postoperative pain and morphine doses were not significantly different between the two groups. Compared to the non-tourniquet group, the tourniquet group had a significantly increased blood loss in the drain (mean difference: 94.40 ml; 95% CI 3.65-185.14; P = 0.04). No significant differences in the operative time and muscle strength were found between the two groups. Tourniquet use was associated with a greater decrease in thigh girth but not in calf girth.

Conclusions: The current evidence shows that compared to tourniquet use, ACL reconstruction surgery without tourniquet does not appear to have any major disadvantages and does not prolong operation time. There might be less drain blood loss associated with tourniquet use, though drains are no longer routinely used in ACL reconstruction surgery.

Keywords: Anterior cruciate ligament; Arthroscopy; Knee; Meta-analysis; Systematic review; Tourniquet.

Conflict of interest statement

Ethics approval and consent to participate

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

PRISMA flow diagram of the study

Fig. 2

Risk of bias summary: authors’ judgments about each risk of bias item for each included study. The “−” sign means low risk of bias, the “+” sign means high risk of bias, and the “?” sign means unclear risk of bias

Fig. 3

Forest plot of patient-reported pain score for tourniquet group versus non-tourniquet group. There was no significant difference in patient-reported pain score 6 h after surgery between the tourniquet and non-tourniquet groups

Fig. 4

Forest plot of patient-reported pain score for tourniquet group versus non-tourniquet group. There was no significant difference in patient-reported pain score 22 h after surgery between the tourniquet and non-tourniquet groups

Fig. 5

Forest plot of postoperative morphine consumption for tourniquet group versus non-tourniquet group. There was no significant difference in required postoperative morphine doses between the tourniquet and non-tourniquet groups

Fig. 6

Forest plot of operation time for tourniquet group versus non-tourniquet group. There was no significant difference in postoperative operation time between the tourniquet and non-tourniquet groups

Fig. 7

Forest plot of blood loss in surgical drain for tourniquet group versus non-tourniquet group. The tourniquet group had 94.4 ml more blood loss in the surgical drain than did the non-tourniquet group

Fig. 8

Forest plot of isokinetic quadriceps strength (60°/S) at 6 months after surgery for tourniquet group and non-tourniquet group. There was no significant difference in isokinetic quadriceps strength at 60°/S at 6 months after surgery between the tourniquet and non-tourniquet groups