title: Ankle arthroscopy: a study of tourniquet versus no tourniquet.
abstract: BACKGROUND
  More than 10,000 ankle arthroscopy procedures are performed in the United Kingdom annually. Tourniquet use is thought to allow improved visibility and reduce operative time. However this is not without risk as it predisposes to neurovascular injury. The purpose of our study was to establish the feasibility of a subsequent larger randomized controlled trial, to test the hypothesis that tourniquet use might be unnecessary in ankle arthroscopy.
  
  
  METHODS
  We performed a prospective nonrandomized case control study on 63 patients undergoing ankle arthroscopy to assess the feasibility of a randomized control trial comparing tourniquet versus no tourniquet. All patients had a tourniquet placed on the thigh and a standard arthroscopic technique. In 1 group (n = 31) the tourniquet was routinely inflated, whereas in a second group (n = 32) the tourniquet was not inflated. Demographic data, intraoperative fluid pressures, and visibility were recorded, as were any intraoperative or postoperative complications.
  
  
  RESULTS
  There were no significant differences between the 2 groups with respect to duration of operation, maximum intraoperative fluid pressures or visibility, and postoperative complications. In no cases where a tourniquet was not used did the surgeon need to inflate the tourniquet during the case.
  
  
  CONCLUSIONS
  Most orthopaedic surgeons continue to use a tourniquet routinely for ankle arthroscopy, presumably on the belief that a clear operative view can be achieved only with a tourniquet. The findings of our feasibility study revealed that ankle arthroscopy was possible without the use of a tourniquet. We propose a randomized clinical trial to determine the best option for patient care.
  
  
  METHODS
  Level III, comparative series.
authors.affiliation: Royal National Orthopaedic Hospital, NHS Trust, Stanmore, UK.
authors.forename: Razi
authors.initials: R
authors.lastname: Zaidi
authors.forename: Kamrul
authors.initials: K
authors.lastname: Hasan
authors.forename: Aadhar
authors.initials: A
authors.lastname: Sharma
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cullen
authors.forename: Dishan
authors.initials: D
authors.lastname: Singh
authors.forename: Andrew
authors.initials: A
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D014111:Tourniquets; D016896:Treatment Outcome
keywords: ankle; arthroscopy; tourniquet; visibility