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Tourniquet Use Improves Intra-Operative Parameters Leading to Similar Post-Operative Outcomes Compared No Tourniquet Use in Anterior Cruciate Ligament Reconstruction: A Prospective, Double-Blind, Randomized Clinical Trial

  • Hamood H.G. Zaid
    Affiliations
    The First Affiliated Hospital of Xiamen University No. 55 Zhenhai Street, Siming District, Fujian province, Xiamen city, Postal Code: 361026, China

    College of Integrative Medicine, Fujian University of Traditional Chinese Medicine,No. 282, Wusi Road, Gulou District , Fujian province, Fuzhou city 350122, China
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  • Xu Hua
    Affiliations
    The First Affiliated Hospital of Xiamen University No. 55 Zhenhai Street, Siming District, Fujian province, Xiamen city, Postal Code: 361026, China
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  • Binyi Chen
    Affiliations
    The First Affiliated Hospital of Xiamen University No. 55 Zhenhai Street, Siming District, Fujian province, Xiamen city, Postal Code: 361026, China
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  • Quanyuan Yang
    Affiliations
    The First Affiliated Hospital of Xiamen University No. 55 Zhenhai Street, Siming District, Fujian province, Xiamen city, Postal Code: 361026, China
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  • Guo Yang
    Correspondence
    Corresponding Author: Guo Yang, MS, Department of Sports Medicine, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Street, Siming District, Fujian province, Xiamen city, Postal Code: 361026, China. Tel: 0086-592-2132222; Fax: 0086-592-2137060;
    Affiliations
    The First Affiliated Hospital of Xiamen University No. 55 Zhenhai Street, Siming District, Fujian province, Xiamen city, Postal Code: 361026, China
    Search for articles by this author
  • Nan Chenwei
    Correspondence
    Corresponding Author: Nan Chenwei, MD, Department of Sports Medicine, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Street, Siming District, Fujian province, Xiamen city, Postal Code: 361026, China. Tel: 0086-592-2132222; Fax: 0086-592-2137060;
    Affiliations
    The First Affiliated Hospital of Xiamen University No. 55 Zhenhai Street, Siming District, Fujian province, Xiamen city, Postal Code: 361026, China
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Published:November 02, 2022DOI:https://doi.org/10.1016/j.arthro.2022.10.033

      Abstract

      Purpose

      To examine the effect of tourniquet use in arthroscopic ACL reconstruction in terms of: (1) intraoperative visualization with operative time and consumption of sterile saline, and (2) intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum creatine phosphokinase (CPK) hemoglobin concentration (Hb), clinical outcomes, and graft healing.

      Methods

      In this prospective randomized clinical trial, patients were assigned to tourniquet inflation (tourniquet-up) or tourniquet deflation (tourniquet-down) groups. Primary outcomes were intraoperative visualization with operative time and sterile saline consumption. Secondary outcomes were intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum creatine phosphokinase (CPK) ,hemoglobin concentration (Hb), subjective and objective functional scores, and graft healing.

      Results

      Intraoperative visualization was satisfactory in 100 of 100 cases in the tourniquet-up group and 64 of 100 cases in the tourniquet-down group (P < .05). The mean operative time was 58.4 ± 5.7 min in the tourniquet-up group and 72.5 ± 8.6 min in the tourniquet-down group (P < .05). The mean sterile saline consumption was 6.4 ± 2.5 L in the tourniquet-up group, and 8.7 ± 4.6 L in the tourniquet-down group (P < .05). The respective amounts of estimated intraoperative and postoperative blood loss were 95.3 ± 25.1 and 240.3 ± 44.5 mL in the tourniquet-up group and 230.2 ± 22.3 and 75.6 ± 15.3 mL in the tourniquet-down group (P < .05). Our results showed no significant difference in postoperative pain, opioid consumption, percentage of patients using opioids, swelling, mean serum CPK level, Hb level, subjective and objective functional scores, or graft healing (P > .05) between the two groups.

      Conclusions

      Tourniquet utilization during ACL reconstruction significantly improves intraoperative visualization, shortens operative time, and decreases intraoperative sterile saline consumption and blood loss without serious adverse events or higher complication rates based on early postoperative outcomes.
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