Is It Better to Routinely Use Tourniquet for Knee Arthroscopic Surgery: A Systematic Review and Meta-analysis

Wang, Jinyou; Xu, Wennan; Lv, Jiayin

doi:10.1055/s-0039-1688555

Cited by 13 publications

(6 citation statements)

References 27 publications

(84 reference statements)

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“…On the other hand, knee arthroscopy can be performed without a tourniquet or under a tourniquet. 20 The potential advantages and disadvantages of these methods are beyond the scope of our study. In our clinic, we routinely perform knee arthroscopy under a tourniquet.…”

Section: Discussionmentioning

confidence: 92%

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention

2021

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Knee arthroscopy is one of the most common surgical procedures in orthopaedics and especially in sports medicine. Portal problems and effusion after knee arthroscopy have been reported. The fluid retention within the joint in knee arthroscopy can affect clinical outcomes, but there is no consensus on portal management. The studies of portal management in knee arthroscopy have mainly addressed wound healing and cosmetic problems. There is insufficient information in the literature about whether the irrigation fluid used in this effusion contributes to the process. This study investigates whether arthroscopic irrigation fluid is retained in the joint and whether portal-closure management has an effect on effusion. In this randomized, prospective study, 91 patients (46 [50.5%] sutured-portal group and 45 [49.5%] open-portal group) were included. Suprapatellar knee-diameter measurement and the number of times the dressing was changed were used to assess intra-articular fluid collection. The visual analog scale (VAS) score, Oxford knee score, and Knee Society score were used to evaluate knee problems. All portal wounds in both groups healed without any problems. Superficial or deep infection was not observed in either group. There was no statistically significant difference in VAS score, Oxford knee scores, and Knee Society scores between groups. Although there was a decrease in the knee diameter of both groups between the early postoperative period and first postoperative day, a statistically significant difference in knee diameter was found, especially in the open-portal group. There was a significant difference between the groups in terms of the number of dressings used in the first 24 hours after surgery. Leaving portals open may be effective in preventing intra-articular fluid retention. We thus advise leaving the arthroscopy portals open with just a simple dressing for selected patients.

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Section: Discussionmentioning

confidence: 92%

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention

2021

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Section: Recommendations Regarding Arthroscopymentioning

confidence: 99%

“…257 A more recent systematic review and meta-analysis suggested that the visualization benefit was more historic and that when directly compared, the use of a no tourniquet for simple knee arthroscopy resulted in decreased post-operative opioid requirement and less post-operative blood loss with no difference in operative time, post-operative pain score between groups, or post-operative functional strength. 258 Tranexamic acid has been found to reduce post-operative swelling, hemarthrosis incidence, and improve early postoperative function in total joint arthroplasty. 259 As such its use in knee arthroscopy has increased in use as a mechanism to both improve visualization and decrease symptomatic post-operative hemarthrosis.…”

Section: Surgical Considerationsmentioning

confidence: 99%

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

Hunter¹,

Deer²,

Jones³

et al. 2022

JPR

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Knee pain is second only to the back as the most commonly reported area of pain in the human body. With an overall prevalence of 46.2%, its impact on disability, lost productivity, and cost on healthcare cannot be overlooked. Due to the pervasiveness of knee pain in the general population, there are no shortages of treatment options available for addressing the symptoms. Ranging from physical therapy and pharmacologic agents to interventional pain procedures to surgical options, practitioners have a wide array of options to choose from – unfortunately, there is no consensus on which treatments are “better” and when they should be offered in comparison to others. While it is generally accepted that less invasive treatments should be offered before more invasive ones, there is a lack of agreement on the order in which the less invasive are to be presented. In an effort to standardize the treatment of this extremely prevalent pathology, the authors present an all-encompassing set of guidelines on the treatment of knee pain based on an extensive literature search and data grading for each of the available alternative that will allow practitioners the ability to compare and contrast each option.

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“…Compared with the study of Schwab et al, patients' HBL after BOWHTO in our study was not only lower than that of TKA patients but also significantly higher than that of UKA. The HBL after BOWHTO is much higher than the dominant blood loss, which is closely related to the surgical method of osteotomy itself; factors such as intraoperative release of soft tissue, unsealed osteotomy sectioning, and routine application of tourniquet are the key factors that cause recessive blood loss [9,18]. In clinical practice, we often find that patients can experience noticeable silt and redness at the distal end of the incision at 3-5 days after surgery that may even be combined with wound oozing, which is often caused by the accumulation of HBL under the skin and is a potential risk of wound infection.…”

Section: Comparison With Other Knee Operationsmentioning

confidence: 99%

Does the correction angle affect hidden blood loss in HTO?

Zheng¹,

Wang²,

Cao³

et al. 2020

J Orthop Surg Res

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Background High tibial osteotomy (HTO) has a history of nearly 60 years and has been widely used in clinical practice. Biplanar open wedge high tibial osteotomy (BOWHTO), which evolved from HTO, is an important therapy for the knee osteoarthritis. In our previous research, we found that the decrease of hemoglobin levels after high tibial osteotomy ranges from between 17 to 41 g/L, but this is highly inconsistent with the intraoperative bleeding and postoperative drainage observed in clinical practice. The purpose of this study was to investigate the perioperative hidden blood loss (HBL) after biplanar open wedge high tibial osteotomy (BOWHTO), as well as to study the effect of the actual correction angle on blood loss. Methods A retrospective analysis was performed on 21 patients who underwent BOWHTO for osteoarthritis of the knee due to proximal tibia deformity. Gross equation was used to calculate the perioperative total blood loss (TBL) and HBL. The actual correction angle was measured by postoperative anteroposterior radiograph. The correlation between HBL and correction angle was determined through correlation analysis. Results The TBL was 823.5 ± 348.7 mL and the HBL was 601.6 ± 297.3 mL, total hemoglobin loss was 25.0 ± 10.7 g/L, and the mean HBL/patient’s blood volume (H/P) was 13.19 ± 5.56% for 21 patients. The correlation coefficient of correction angle and H/P is statistically significant (|r| = 0.678, P = 0.001). Conclusions The actual total blood loss after BOWHTO was significantly higher than the observed, and the HBL was objective existent after BOWHTO. The proportion of H/P is positively correlated with the correction angle.

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Is It Better to Routinely Use Tourniquet for Knee Arthroscopic Surgery: A Systematic Review and Meta-analysis

Cited by 13 publications

References 27 publications

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

Does the correction angle affect hidden blood loss in HTO?

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