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.

Abstract

To assess the effects of tourniquet use on operative time, muscular injury, and postoperative pain in anterior cruciate ligament reconstruction. 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. 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%). 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 I, meta-analysis of level I studies.