Tourniquet Use During Anterior Cruciate Ligament Reconstruction Is Associated With Postoperative Quadriceps Atrophy and Pain but No Negative Effects in the Long Term: A Systematic Review

Abstract

Purpose

To evaluate the effect of tourniquet use during ACL reconstruction on quadriceps strength, intraoperative and postoperative blood loss, operative time, thigh girth or calf girth, and postoperative pain.

Methods

A systematic review using PubMed, EMBASE, and Cochrane Database of Systematic Reviews was conducted following the PRISMA guidelines. Randomized controlled trials and nonrandomized studies that evaluated intraoperative and postoperative effects of tourniquet usage during arthroscopic ACL reconstruction published between November 1996 and January 2023 were included. Outcomes evaluated included intraoperative visualization, pain, quadricep strength thigh or calf girth, blood loss, and operative time.

Results

Eight studies with 502 total patients were included in this review. There were 253 total patients in the tourniquet (T) group and 249 in the non-tourniquet (NT) group. Postoperative blood loss was higher in the T group (P < .05). Two studies reported significantly increased postoperative analgesic usage within the T group (P < .05), while 2 studies listed no significant differences between groups. Postoperative pain was not significantly increased in either group 2 days postoperation; however, 2 studies reported an increase in pain in the T group within the 10-hour, postoperative window (P <.05). Although 3 studies indicated an initial decrease in quadriceps strength within the T group following surgery (P < .05), overall findings consistently demonstrated a recovery of quadriceps strength within a few weeks. Similarly, there were no long-term significant differences in thigh or calf girth reported. Decreased operative time was reported with tourniquet use across included studies with 1 study demonstrating a significant difference (P < .05).

Conclusions

Tourniquet use during ACL reconstruction does not have negative long-term effects on quadriceps strength. Although tourniquet use was associated with increased quadriceps atrophy and pain in the immediate postoperative period, these effects did not persist.

Level of Evidence

Level II, systematic review of Level I and II studies.