Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Abstract

Background: Deep venous thrombosis (DVT) and pulmonary embolism are serious potential complications after anterior cruciate ligament reconstruction (ACLR). Little is known about the influence of tourniquet use on the incidence of DVT after ACLR. Purpose: To compare the incidence of DVT after ACLR with and without the use of a tourniquet. Study Design: Cohort study; Level of evidence, 3. Methods: Between November 2018 and May 2020, a total of 60 consecutive ACLRs in 60 patients, including 7 revision surgeries, were performed without tourniquet use at our hospital and were enrolled in this study (T– group). In addition, 55 consecutive ACLRs in 55 patients, including 10 revision surgeries, were performed with tourniquet use between April 2017 and September 2018 and were enrolled as the control group (T+ group). DVT was diagnosed using ultrasonography of both legs performed preoperatively and at postoperative week 1. The incidence of postoperative DVT was compared between the T– and T+ groups. Logistic regression analysis was performed to evaluate the effect of older age (≥40 vs <40 years) and tourniquet use on the occurrence of DVT. Results: No DVTs were detected preoperatively. The incidence of postoperative DVT was significantly lower in the T– group compared with the T+ group (1 patient [1.7%] vs 9 patients [16.4%]; P = .005). All patients with DVT were asymptomatic. Although the mean operative time was not significantly different (80.8 minutes in the T+ group vs 78.5 minutes in the T– group; P = .461), the mean blood loss from the drain was significantly lower in the T– group than in the T+ group (149.9 vs 201.9 mL; P < .001). Age ≥40 years and tourniquet use were significantly related to the occurrence of DVT (odds ratio, 8.3 [95% CI, 1.9-36.8]; P = .005; and odds ratio, 8.8 [95% CI, 1.0-75.3]; P = .047, respectively). Conclusion: ACLRs performed without tourniquet resulted in a significantly lower incidence of DVT after ACLR and significantly less bleeding from drains. If adequate visibility of the surgical field is obtained, ACLR without tourniquet use may reduce the incidence of DVT.