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Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 575 - 576
1 Aug 2008
George HL Kumar G Mereddy PKR Harvey RA
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Background: Tourniquet provides a blood less field for surgery, but it has few complications and contraindications. There are several studies identifying the tourniquet as a factor for increased risk of complications in knee arthroscopy, we reviewed 200 consecutive knee arthroscopies done in our hospital with out tourniquet to analyse the outcome.

Aim: To analyse the out come of 200 knee arthroscopies done with out use of tourniquet; with respect to visualisation, time of surgery, bleeding, analgesia and post operative complications.

Materials and methods: We retrospectively analysed 200 consecutive knee arthroscopies with out tourniquet done in our institute. Average age of these patients was 39 (21–81). All patients underwent soft tissue procedures under general anaesthesia, supine, with sole support, no antibiotics and were done by same surgeon as day case. Same arthroscopic kit (Dyonics) with pump was used for all patients, using 2 litre saline bag and pump set at 65 mm Hg pressure. First few cases had tourniquet applied but not inflated, but later even this was avoided. Procedures included were diagnostic arthroscopies, arthroscopic debridements, meniscal repairs and partial or complete meniscal resections. Procedures like arthroscopic ACL reconstruction and other bony procedures were excluded. We looked at any visualisation problems, time of surgery, bleeding, analgesia and post operative complications. We also looked weather any of these patients visited the consultant or GP for any wound related problem or pain before the usual review at 2 weeks.

Results: There was no problem with visualisation noted in any of the cases, or any incidence where arthroscopy was unduly prolonged. There was no incidence of bleeding, stiffness or increased need for analgesia in any of these patients. None of the patients had any wound problem or haemathrosis requiring intervention. There was no record of any patients reattending the clinic or their GP for pain or bleeding.

Conclusions: Many orthopaedic units continue to use a tourniquet routinely for soft tissue procedures in knee arthroscopy, probably in the belief that a clear operative view can only be achieved with one. However, the findings in our study indicate that knee arthroscopy for soft tissue procedures may be performed adequately without the use of a tourniquet provided a pump system is used and the pressure maintained above venous pressure. Therefore we recommend that its use for routine soft tissue arthroscopic procedures be discontinued.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_I | Pages 54 - 54
1 Jan 2003
Chowdhury EAH Harvey RA Parkinson RW
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Review of 133 cases of Anterior Cruciate Ligament (ACL) reconstruction, showed 91 cases had been arthroscoped twice. The incidence of meniscus pathology, at first arthroscopy was 71% and this fell to 63% at the second arthroscopy and reconstruction. 21% of recurrent tears were in previously undamaged menisci. The medial meniscus, was the most commonly damaged meniscus, at the time of the first arthroscopy. The incidence of lateral and bilateral meniscus pathology increased in the time period awaiting ACL reconstruction. The mean time between the two arthroscopies were 27 months. Damaged menisci continued to tear over the time period between first and second arthroscopies or new pathology occurred. The paper concludes that if ACL reconstruction is performed by a mini open technique then it should be re-arthroscoped immediately before the ACL reconstruction. This is essential to avoid missing meniscus pathology, even in previously arthroscoped knees.