The Role of Tourniquet Use in Arthroscopic Meniscectomy: A Systematic Review

<b>Background and Objectives:</b> The role of tourniquet use in arthroscopic partial meniscectomy remains debatable. While traditionally adopted to enhance visualization and reduce intraoperative bleeding, concerns were raised regarding its impact on postoperative outcomes and potential adverse effects, such as muscle damage or delayed recovery. This systematic review aimed to evaluate whether the use of a tourniquet offers advantages in terms of surgical efficiency, patient recovery and complication rates in arthroscopic partial meniscectomy. <b>Materials and Methods:</b> A systematic review was conducted following PRISMA guidelines and registered in the PROSPERO database (CRD42025644740). A comprehensive literature search was performed in 5 databases including studies from the past 20 years. Only randomized controlled trials (RCTs) comparing tourniquet-assisted versus non-tourniquet procedures in adolescent and adult patients undergoing isolated arthroscopic partial meniscectomy matched our inclusion criteria and the analysis was performed on those. Methodological quality was assessed using the Cochrane RoB 2.0 tool. Data were synthesized either quantitatively or narratively, depending on the availability of statistical details. <b>Results:</b> Three RCTs with a total of 243 patients met the inclusion criteria. Operative time was shorter in tourniquet-assisted procedures in one study (<i>p</i> = 0.001), though comparable outcomes were achieved in non-tourniquet groups when pharmacological agents such as intra-articular adrenaline were used. No significant differences were observed between groups regarding postoperative pain (<i>p</i> = 0.22, <i>p</i> = 0.43), knee effusion (<i>p</i> = 0.96), range of motion (<i>p</i> = 0.91, <i>p</i> = 0.96), or time to return to functional activities (<i>p</i> = 0.9, <i>p</i> = 0.34, <i>p</i> = 0.23). Muscle damage, assessed by serum creatine phosphokinase CPK levels, did not differ between groups (<i>p</i> = 0.3, <i>p</i> = 0.093, <i>p</i> = 0.079). Intraoperative visibility and surgeon satisfaction rated higher in tourniquet groups (<i>p</i> = 0.002), although this was subjective and reported variably. No major tourniquet-related complications were recorded. <b>Conclusions:</b> The routine use of a tourniquet in arthroscopic partial meniscectomy provides limited intraoperative advantages and does not improve postoperative outcomes. Current evidence supports a selective rather than routine use of tourniquets, especially when pharmacological alternatives are available. Further high-quality studies are needed to define standardized protocols and assess long-term outcomes.