Postmeniscectomy tourniquet palsy and functional sequelae

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 the 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 the sound leg. The results were: 17 of 24 (71%) of the tourniquet group had EMG evidence of denervation and a functional capacity of 39% of the normal leg. 7 of 24 (29%) of the tourniquet group had no evidence of denervation and a 71% functional capacity. 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.