The purpose was to compare the intra- and post-operative outcomes of tourniquet assisted to non-tourniquet-assisted surgery during arthroscopic knee procedures. A systematic review was undertaken of the electronic databases MEDLINE, CINAHL, AMED and EMBASE, in addition to a review of unpublished material and a hand search of pertinent orthopaedic journals. The evidence-base was critically appraised using the Cochrane Bone, Joint and Muscle Trauma Group quality assessment tool. Study heterogeneity was statistically measured using the Chi(2) and I(2) statistical tests. When appropriate, a random-effect meta-analysis was undertaken to pool the results of the primary studies assessing the mean difference of each outcome. Nine studies were identified evaluating seven outcome measures and parameters. Arthroscopic ACL reconstruction knee surgery with a tourniquet experienced less operative visualisation difficulties compared to surgery without a tourniquet. There was no significant difference between tourniquet and non-tourniquet arthroscopic knee surgery for all other outcomes. The evidence-base exhibited a number of methodological limitations. There is limited evidence to suggest that a tourniquet assists in arthroscopic knee surgery. The methodological quality of the present evidence-base remains weak. Further study is required to answer this research question.