Postmeniscectomy tourniquet palsy and functional sequelae

Abstract

A pattern of variability was noted in the rehabilitative progress of patients undergoing knee surgery. Forty-eight patients who underwent routine medial or lateral meniscectomy were studied in a controlled, randomized, prospective investigation designed to identify electromyographic (EMG) and functional deficits associated with using a pneumatic tourniquet in knee surgery. The control group (24 individuals) underwent knee surgery without te use of a tourniquet. Six weeks postoperatively all patients were studied by EMG and functionally by determining the single leg vertical leap of the affected leg and expressing this as a percentage of that accomplished by th sound leg. The results were: (1) 17 of 24 (71%) of the tourniquet group had EMG evidence of denervation and a functional capacity of 39% of the normal leg. (2) 7 of 24 (29%) of the tourniquet group had no evidence of denervation and a 71% functional capacity. (3) The control group had no evidence of denervation and a functional capacity of 79%. Of the patients on whom a tourniquet was used, total tourniquet time and pressure did not vary significantly between those patients who demonstrated EMG findings and those who did not. Arthrotomy in the absence of a tourniquet required more attention to hemostasis, but did not present overwhelming difficulty. Operative time was slightly prolonged. This investigation suggests that the ideal of early return to functional activity after knee surgery can best be accomplished by avoiding use of a pneumatic tourniquet.

Structural assessment of rat sciatic nerve following tourniquet compression and vascular manipulation

“…The findings of the present study add further evidence that higher tourniquet pressures (500-1,000 mm Hg) used by other investigators (Paletta et al, 1960;Ochoa et al, 1972;Makitie and Teravainen, 1977) were not necessary to produce a nerve lesion similar to that observed clinically Saunders et al, 1979;Dobner and Nitz, 1982).…”

Does Patellar Eversion in Total Knee Arthroplasty Cause Patella Baja?

“…Although the cause of patella baja after TKA is multifactorial, it appears from previous studies that a lateral release is consistently associated with an increased risk [18,26]. The use of a tourniquet has also been associated with patella baja [2,8]. We inflate the tourniquet only during preparation of the tibial keel and cementation.…”

Function of Fast- and Slow-Twitch Rat Skeletal Muscle following Ischemia and Reperfusion at Different Intramuscular Temperatures

“…Tourniquet ischemia ensures a good overview in a bloodless operation field and reduces blood loss. However, tourniquet-induced ischemia and reperfusion can induce a variety of structural and metabolic changes that may ultimately lead to an increase in postoperative edema [2], impaired wound healing [2], prolonged rehabilitation time [3] and a long-lasting reduction in postoperative muscle function [3,4]. These complications have prompted research in the area of ischemic injury and postischemic skeletal muscle function.…”