title: The effect on leg strength of tourniquet use during anterior cruciate ligament reconstruction: A prospective randomized study.
abstract: OBJECTIVE
  The purpose of this study was to prospectively evaluate the effect of tourniquet use during endoscopic anterior cruciate ligament (ACL) reconstruction surgery on dorsiflexion strength, plantarflexion strength, quadriceps strength, and calf and thigh girth.
  
  
  METHODS
  The study was a prospective, double-blind, randomized clinical trial.
  
  
  METHODS
  Forty-eight patients were prospectively randomized into 2 groups: (1) tourniquet use during surgery (T) and, (2) no tourniquet use during surgery (NT). Within 1 week before ACL reconstruction, all patients were evaluated for isometric plantarflexion and dorsiflexion strength, thigh strength, and thigh and calf girth. These same measurements were repeated 3 weeks postoperatively. At 6 months, isokinetic quadriceps strength was evaluated at 60 degrees per second. All patients underwent ACL reconstruction using a patella-tendon autograft and a tourniquet was placed on the affected extremity. In all 25 T patients, the tourniquet was inflated to 300 mm Hg. The average tourniquet time was 85 +/- 7 minutes (range, 51 to 114 minutes).
  
  
  RESULTS
  ACL reconstruction resulted in a significant decrease in thigh girth (P <.01), calf girth (P <.01), dorsiflexion strength (P <.01), and plantarflexion strength (P <.05) at 3 weeks postoperatively in both groups. The T group had a greater decrease in thigh girth than the NT group (P <.05). Tourniquet use did not have an effect on calf girth (P =.53), dorsiflexion strength (P =.17), or plantarflexion strength (P =.32) at 3 weeks postoperatively. Tourniquet use also had no effect on quadriceps strength at 6 months postoperatively (P =.78).
  
  
  CONCLUSIONS
  Tourniquet use of less than 114 minutes during ACL reconstruction had no effect on the strength of the lower extremity after surgery.
authors.affiliation: Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York 10021, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Nicholas
authors.forename: T F
authors.initials: TF
authors.lastname: Tyler
authors.forename: M P
authors.initials: MP
authors.lastname: McHugh
authors.forename: G W
authors.initials: GW
authors.lastname: Gleim
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001284:Atrophy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007537:Isometric Contraction; D007866:Leg / Q000503:physiopathology*; D008297:Male; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000473:pathology* / Q000503:physiopathology; D010329:Patella / Q000637:transplantation; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D013710:Tendons / Q000637:transplantation; D013718:Tensile Strength; D014111:Tourniquets / Q000009:adverse effects*; D016896:Treatment Outcome