Efficacy of the “local anaesthetic injection technique” in anterior cruciate ligament reconstructions of professional soccer players

Abstract

BackgroundThere are very little data in orthopaedic literature about ACL reconstruction, without use of tourniquets. One of the alternatives to pneumatic tourniquets in ACL surgery is the “injection technique” described by Furia and Zambetti. Between 1994 and 2000, we preferred to apply this local anaesthetic technique in ACL reconstruction operations lasting more than 2h in 576 professional athletes. HypothesisThis technique gives more time to the senior surgeon for training resident surgeons and almost same bloodless field as visible as tourniquet usage in ACL senior surgery. Study designLevel of evidence: IV (case series, prospective study of previously collected data). MethodsIn 576 cases, injections of “Solution 1” (lidocaine and epinephrine, for skin and subcutaneous injection) and “Solution 2” (bupivicaine and epinephrine, for intra-articular injection) were administered without inflating the preapplied pneumatic tourniquet. After performing a diagnostic arthroscopy or a surgical arthroscopic procedure, we reconstructed the ACL with a BTB autograft through a mini anterior arthrotomy incision. All major or minor complications due to the injections were carefully recorded. ResultsThe mean operation time was 165min in patients without co-existing cartilage or meniscal pathology and 205min in patients with co-existing pathologies. No cardiovascular complications were recorded. The bloodless field was obscured in only seven patients (1.2%). Partial wound edge cyanosis was noted in 18 patients (3%) near the graft harvesting incisions, making the overall complication rate of this “injection technique” 4.3%. ConclusionThis technique gave superior visibility as tourniquet usage in 98.8% cases and also gave more time to the surgeon for resident education. So the surgeon did not have to worry about tourniquet times.