The effect of tourniquet on early postoperative quadriceps muscle wasting in ACL arthroscopic surgery

Background: The main goals of anterior cruciate ligament (ACL) reconstruction and rehabilitation are to reestablish knee function. Quadriceps weakness is one of the most important complications associated with ACL injury and represents a major rehabilitation challenge. This study is designed to test the early effect of tourniquet on muscle wasting and to differentiate weather it is because muscle disuse or injury. Methods: Twenty six male patients who submit to arthroscopic ACL reconstruction were randomly assigned to the use of an inflated (group T, n _ 13) or deflated (group NT, n _ 13) tourniquet. Patients with preoperative quadriceps wasting or abnormal electro conductive studies were excluded. The primary measures were thigh girth preoperatively and after two weeks, serum creatinine phosphokinase (CPK) preoperatively and one day postoperatively and electro conductive studies preoperatively and 1 month postoperatively. Results: Patients' mean age was comparable in both groups. There was a significant difference between T and NT groups in term of thigh girth, CPK and electro conductive studies. Mean thigh girth in T group was 2.6 ± 0.5 while in NT group 1.4 ± 0.5. Mean CPK in T group was 813 ± 149 while in NT group 520 ± 203. Mean femoral latency was 1.85 ± 0.4 in T group and 1 ± 0 in NT group; mean femoral conduction velocity was 1.77 ± 0.4 in T group and 1 ± 0 in NT group; mean muscle denervation was 1.92 ± 0.3 in T group and 1.54 ± 0.5 in NT group; mean motor unit number estimation was 1.9 ± 0.3 in T group and 1.5 ± 0.5 in NT group. Conclusion: This comparative study show that tourniquet play a significant role in direct muscle injury proved by measurement of postoperative CPK and thigh girth in T group comparing it with NT group.