The use of a tourniquet for knee arthroscopy is standard
for some surgeons, while others prefer not to use one. The decision
not to use a tourniquet is supported by randomized trials that have shown
electromyographic changes or delay in functional recovery with the
use of a tourniquet in knee surgery. However, these studies involved patients
who received either anterior cruciate ligament reconstruction or
open meniscectomy and are therefore not generalizable to simple
knee arthroscopy1,2
. This study by Kirkley and colleagues focused exclusively on the
latter.
This double-blind, randomized clinical trial evaluated outcomes that
are relevant to patients, such as pain, health status, and time to
return to work and sport. The only statistically significant difference
between the 2 groups was for postoperative pain in patients whose
surgery lasted >30 minutes. While not achieving statistical significance,
the no-tourniquet group returned to work 2.8 days earlier (15.4
vs. 18.2), returned to sport 7.3 days earlier (20.9 vs. 28.2), and
had improved isokinetic knee flexion and extension at 2 weeks (16%
and 20%, respectively). The sample size calculations were not based
on these variables, and it is possible that there was not sufficient
power to detect a statistically significant difference for these
comparisons. While this study was not limited to athletic patients,
it could have implications for knee arthroscopy in athletes for whom
a prompt return to competition is desired.
The use of a tourniquet for simple knee arthroscopy has, at most,
a small negative effect on patient function in the first two weeks
post-surgery, but no effect in the longer term.
Robert G. Marx, M.D., M.Sc., F.R.C.S.(C)
Sports Medicine and Shoulder Service
Hospital for Special Surgery
New York, N.Y.