Arthroscopic anterior cruciate ligament reconstruction with and without tourniquet use: an updated systematic review and meta-analysis on clinical outcomes

Abstract

Abstract Background The use of a tourniquet is common during anterior cruciate ligament (ACL) reconstruction, offering convenience for the surgical procedure. However, the potential adverse effects of tourniquet use have gained increasing attention from clinical researchers. We conducted this systematic review and meta-analysis to compare the clinical outcomes of tourniquet application versus non-tourniquet approach during arthroscopic ACL reconstruction. Methods A comprehensive search of PubMed, Web of Science, Embase, and Cochrane Library databases, was performed through March 2023 to identify controlled clinical trials. The main outcomes assessed included post-operative drain output, post-operative pain using a visual analogue scale (VAS), operation time, calf girth, and thigh girth. A random-effects meta-analysis was performed to account for heterogeneity, with weighted mean difference (WMD) and 95% confidence intervals (CI) used as pooled estimates for clinical outcomes. Results Of the nine potentially related studies, seven eligible studies (sufficient quantitative data) were included in the meta-analysis. Postoperative drain output in the tourniquet group was on average 100 ml higher than in the non-tourniquet group (95% CI: 36 to 168). Pain, measured by the VAS at 24 h postoperatively, was 0.42 points higher in the tourniquet group (95% CI: 0.08 to 0.76), with the increase persisting at 48 h, averaging 0.40 points (95% CI: 0.12 to 0.69). Thigh girth in the tourniquet group was reduced by 1.8 cm (95% CI: -2.7 to -0.94). No significant differences were observed for calf girth and the operation time. Conclusion Our meta-analysis indicates that tourniquet use during arthroscopic ACL reconstruction is associated with higher pain levels, increased postoperative drain output, and reduced thigh girth. However, performing the surgery without a tourniquet does not significantly extend the operation time. Trial registration The protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023417604).

Keywords

• Anterior cruciate ligament
• Knee
• Surgery
• Tourniquet
• Arthroscopy
• Drain output