Tourniquet Use In Anterior Cruciate Ligament Reconstruction May Decrease Operative Time but Is Associated With Muscular Injury and Postoperative Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Yang Yang; Meng-Qin Zhang; Jian-Min Zhang; Wei Zhang; Xiao-Bo Zhou; Dan Wang; Tao-Hsin Tung

doi:10.1016/j.arthro.2024.11.082

Tourniquet Use In Anterior Cruciate Ligament Reconstruction May Decrease Operative Time but Is Associated With Muscular Injury and Postoperative Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Arthroscopy. 2024 Dec 2:S0749-8063(24)01012-0. doi: 10.1016/j.arthro.2024.11.082. Online ahead of print.

Authors

Yang Yang¹, Meng-Qin Zhang², Jian-Min Zhang³, Wei Zhang³, Xiao-Bo Zhou³, Dan Wang³, Tao-Hsin Tung⁴

Affiliations

¹ Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Zhejiang, China; Department of Medical Education, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Zhejiang, China.
² Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Zhejiang, China.
³ Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Zhejiang, China.
⁴ Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai City, Zhejiang Province, China. Electronic address: [email protected].

PMID: 39631481
DOI: 10.1016/j.arthro.2024.11.082

Abstract

Purpose: To assess the effects of tourniquet use on operative time, muscular injury, and postoperative pain in anterior cruciate ligament reconstruction.

Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search was performed in EMBASE, PubMed, Web of Science, and the Cochrane Library for relevant randomized controlled trials (level of evidence: Level I), from inception to February 6, 2024. Data extraction included details such as first author, country, publication year, sample size, age, sex, tourniquet parameters (including inflation time and pressure), anesthesia, arthroscopic visualization, operative time, postoperative visual analog score, postoperative blood loss, postoperative morphine consumption within 24 hours, postoperative serum creatine phosphokinase levels, side-to-side thigh circumference difference after 3 weeks of surgery, and knee functional scores at the 6-month follow-up. Studies that met the inclusion criteria were assessed for risk of bias using the Cochrane Collaboration's tool.

Results: Seven randomized controlled trials involving 471 participants were included in this study. Compared with the nontourniquet group, the tourniquet group had a significantly decreased operative time (mean difference [MD] -10.11, 95% confidence interval [CI] -15.74 to -4.49, P = .0004, I² = 49%). In addition, the tourniquet group had significantly increased creatine phosphokinase levels compared with the nontourniquet group (MD 12.70, 95% CI 2.47-22.92, P = .01, I² = 0%). Moreover, the tourniquet group had significantly greater visual analog scores 1 day postoperatively (MD 0.31, 95% CI 0.10-0.53, P = .005, I² = 21%) and significantly greater postoperative blood loss (MD 156.33, 95% CI 134.05-178.60, P < .00001, I² = 63%).

Conclusions: This meta-analysis found that the use of a tourniquet in anterior cruciate ligament reconstruction may decrease operative time but is associated with thigh muscle injury and increased postoperative pain.

Level of evidence: Level I, meta-analysis of level I studies.

Publication types

Review