Effect of tourniquet ischaemia on muscle energy metabolism in meniscectomy patients

Tourniquet use does not affect rehabilitation, return to activities, and muscle damage after arthroscopic meniscectomy: a prospective randomized clinical study

PURPOSE

The purpose of this prospective randomized trial was to examine the effect of tourniquet use on rehabilitation rate, return to work and sport activities, and muscle damage after arthroscopic meniscectomy.

METHODS

Eighty patients who underwent arthroscopic partial meniscectomy were randomly allocated to the use of an inflated (group A, n = 40) or deflated (group B, n = 40) pneumatic tourniquet. Patients with concomitant ligamentous deficiency or grade III and IV chondral lesions were excluded. The primary outcome measures were pain, measured with a visual analog scale (VAS), and knee range of motion (ROM) on days 8 and 15 postoperatively; time required for patients to discontinue the use of crutches; time to return to light activities and moderate sporting activities such as jogging; and serum creatine phosphokinase (CPK) levels monitored preoperatively and on days 1, 8, and 15 postoperatively.

RESULTS

The 2 groups did not differ in terms of age; male-female ratio; body mass index; and preoperative International Knee Documentation Committee, Tegner, and Lysholm scores. Operative time was not significantly different between groups (mean, 27.5 for group A and 31.2 for group B; P = .83). VAS pain scores and knee ROM were not significant between groups (minimum P = .22). The patients progressed to weight-bearing without crutches within 13.4 and 12.9 days for groups A and B, respectively (P = .9). Return to work and jogging did not differ significantly between groups (minimum P = .34). Serum CPK values were also not significantly different between or within groups during consecutive measurements (P = .3). Tourniquet time did not significantly affect postoperative ROM, VAS pain scores, or serum CPK levels (minimum P = .14).

CONCLUSIONS

Tourniquet use for less than 30 minutes during arthroscopic meniscectomy does not affect postoperative pain or return to light work and jogging. In addition, tourniquet-induced muscle damage after arthroscopic meniscectomy, though potentially present locally, is not detectable in the systemic circulation.

LEVEL OF EVIDENCE

Level I, prospective randomized trial.

Cuff width increases the serum biochemical markers of tourniquet-induced skeletal muscle ischemia in rabbits

Tourniquet application is a widely accepted adjuvant technique in extremity surgery. The purpose of this prospective, randomized trial was to evaluate the effect of cuff width on skeletal muscle ischemia-reperfusion injury. A 2- or 4-cm wide curved tourniquet cuff was applied around the midthigh of 36 New Zealand White rabbits and inflated to a pressure of 200 or 400 mm Hg for 2 hours: group A=2 cm to 200 mm Hg; group B=2 cm to 400 mm Hg; group C=4 cm to 200 mm Hg; group D=4 cm to 400 mm Hg. Blood levels of potassium, lactic acid, urea, lactic dehydrogenase, and creatinine phosphokinase MM isoenzyme (CPK-MM) were measured as basic indicators for limb ischemia before tourniquet inflation and 1, 5, and 30 minutes after cuff release.Potassium values did not differ among the 4 groups. Lactic acid and urea concentrations were always higher in the 400 mm Hg groups (B and D) (P<.001). However, cuff width did not affect their levels (P>.16). Lactic dehydrogenase and CPK-MM values were also greater in the 400 mm Hg groups at all times (P<.001). Further subgroup analysis of 200 mm Hg pressure groups showed higher lactic dehydrogenase (P<.02) but not CPK-MM (P>.9) concentrations in group C than in group A during the 30-minute period. At 400 mm Hg, lactic dehydrogenase and CPK-MM values were higher in group D compared with group B only 30 minutes after cuff deflation (P<.001). Broad tourniquets are associated with significantly greater and prolonged elevation of serum biochemical markers of inducible skeletal muscle ischemia-reperfusion injury compared with narrow ones. This difference is more prominent when a wide cuff is inflated to a high pressure.