To undertake a meta-analysis of randomized controlled trials to determine whether routine use of a tourniquet is a better choice for knee arthroscopic procedures.
Randomized controlled trials which evaluated the application of a tourniquet were selected, gathering information about arthroscopic visualization and operative time. The random-effects meta-analysis was performed using relative risk calculated from the raw data.
A total of five eligible studies were selected in this meta-analysis with 471 participants. There was no significant difference in visualization or operative time between the tourniquet and the non-tourniquet group.
There is insufficient evidence to support the hypothesis that patients would benefit from routinely applying a tourniquet. The use of a tourniquet did not show any advantage to arthroscopic procedures.
Level of evidence
Therapeutic randomized controlled trials, Level I.
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Arciero RA, Scoville CR, Hayda RA et al (1996) The effect of tourniquet use in anterior cruciate ligament reconstruction. A prospective randomised study. Am J Sports Med 24:758–763
Bollen S (1997) The effect of tourniquet use in anterior cruciate ligament reconstruction—a prospective randomised study. Am J Sports Med 25(2):275–276
Daniel DM, Lumkong G, Stone ML et al (1995) Effects of tourniquet use in anterior cruciate ligament reconstruction. Arthroscopy 11:307–311
DeLee JC (1985) Complications of arthroscopy and arthroscopic surgery: results of a national survey. Arthroscopy 1(4):214–220
Dobner JJ, Nitz AJ (1982) Post meniscectomy tourniquet palsy and functional sequelae. Am J Sports Med 10(4):211–214
Feinstein AR, Horwitz RI (1982) Double standards, scientific methods, and epidemiologic research. N Engl J Med 307(26):1611–1617
Finsen V, Kasseth AM (1997) Tourniquets in forefoot surgery: less pain when placed at the ankle. J Bone Jt Surg Br 79(1):99–101
Gaunche CA (1995) Tourniquet-induced nerve palsy complicating anterior cruciate ligament reconstruction. Arthroscopy 11:620–622
Gutin B, Warren R, Wickiewicz T et al (1991) Does tourniquet use during anterior cruciate ligament surgery interfere with postsurgical recovery of function? A review of the literature. Arthroscopy 7:52–56
Hoogeslag RA, Brouwer RW, van Raay JJ (2010) The value of tourniquet use for visibility during arthroscopy of the knee: a double-blind, randomized controlled trial. Arthroscopy 26:S67–S72
Hooper J, Rosaeg OP, Krepski B et al (1999) Tourniquet inflation during arthroscopic knee ligament surgery does not increase post-operative pain. Can J Anaesth 46:925–929
Jarrett PM, Ritchie IK, Albadran L et al (2004) Do thigh tourniquets contribute to the formation of intra-operative venous emboli? Acta Orthop Belg 70:253–259
Johnson DS, Stewart H, Hirst P et al (2000) Is tourniquet use necessary for knee arthroscopy? Arthroscopy 16:648–651
Julian PT, Sally G (2011) Cochrane handbook for systematic reviews of interventions. Version 5.1.0. Chapter 8: assessing risk of bias in included studies. http://www.cochrane.org/training/cochrane-handbook
Kieser CL (1992) Complications of arthroscopic knee surgery. Arthroscopy 8:79–83
Kirkley A, Rampersaud R, Griffin S et al (2000) Tourniquet versus no tourniquet use in routine knee arthroscopy: a prospective, double-blind, randomized clinical trial. Arthroscopy 16(2):121–126
Klenerman L (1962) The tourniquet in surgery. J Bone Jt Surg Br 44:937–943
Klenerman L, Crawley J (1977) Limb blood flow in the presence of a tourniquet. Acta Orthop Scand 48(3):291–295
Krebs DE (1989) Isokinetic, electrophysiologic, and clinical function relationships following tourniquet-aided knee arthrotomy. Phys Ther 69:803–815
Moher D, Cook DJ, Eastwood S et al (1999) Improving the quality of reports of meta-analysis of randomised controlled trials: the QUOROM statement. Lancet 354:1896–1900
Mohler RL, Pedowitz RA, Lopez MA et al (1999) Effects of tourniquet compression on neuromuscular function. Clin Orthop Relat Res 359:213–220
Nicholas SJ, Tyler TF, McHugh MP et al (2001) The effect on leg strength of tourniquet use during anterior cruciate ligament reconstruction: a prospective randomized study. Arthroscopy 17(6):603–607
Patterson S, Klenerman L (1979) The effect of the pneumatic tourniquet on the ultrastructure of skeletal muscle. J Bone Jt Surg Br 61:178–183
Rorabeck CH (1980) Tourniquet-induced nerve ischemia: an experimental investigation. J Trauma 20:280–286
Saunders KC, Louis DL, Weingarden SI et al (1979) Effect of tourniquet time on postoperative quadriceps function. Clin Orthop Relat Res 143:194–199
Shaw JA, Murray DG (1982) The relationship between tourniquet pressure and underlying soft-tissue pressure in the thigh. J Bone Jt Surg Am 64(8):1148–1152
Sherman OH, Fox JM, Snyder SJ et al (1986) Arthroscopy- “No problem surgery”. J Bone Jt Surg Am 68:256–265
Small NC (1986) Complications in arthroscopy: the knee and other joints. Arthroscopy 2:253–258
Small NC (1988) Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy 4:215–221
Smith OT, Hing BC (2009) A meta-analysis of tourniquet assisted arthroscopic knee surgery. Knee 16:317–321
Thorblad J, Ekstrand J, Hamberg P et al (1985) Muscle rehabilitation after arthroscopic meniscectomy with or without tourniquet control. Am J Sports Med 13:133–135
Tibrewal SB (2001) The pneumatic tourniquet in arthroscopic surgery of the knee. Int Orthop 12:347–349
Tountas CP, Bergman RA (1977) Tourniquet ischemia: ultrastructural and histochemical observations of ischemic human muscle and of monkey muscle and nerve. J Hand Surg [Am] 2:31–37
Wakai A, Wang JH, Winter DC et al (2001) Tourniquet-induced systemic inflammatory response in extremity surgery. J Trauma 51:922–926
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Zhang, Y., Li, L., Wang, J. et al. Do patients benefit from tourniquet in arthroscopic surgeries of the knee?. Knee Surg Sports Traumatol Arthrosc 21, 1125–1130 (2013). https://doi.org/10.1007/s00167-012-2094-3