Tourniquet-induced restriction of the quadriceps muscle mechanism. Fact or fiction?

Many knee surgeons flex the knee and sometimes also extend the hip before inflating a tourniquet on the thigh. This practice stems from the belief that these manoeuvres prevent excessive strain on the quadriceps during surgery, the assumption being that movement of the muscle is restricted by an inflated tourniquet. We therefore examined, using ultrasound, the movement of the quadriceps muscle above and below the tourniquet before and after inflation. We applied a tourniquet of standard size to the thigh of five volunteers for approximately five minutes. A bubble of air was injected into the quadriceps muscle above the tourniquet and was the proximal point of reference. The musculotendinous junction was the distal point. The movement of the reference point was measured by ultrasound before and after inflation of the tourniquet. Each measurement was repeated with either the knee flexed and the hip extended, or the hip flexed and the knee extended. The mean and standard deviation were recorded. Before inflation the mean amount of passive movement was 1.1 +/- 0.13 cm proximal and 4.0 +/- 0.08 cm distal to the tourniquet, with a range of movement of the knee of 0 degrees to 137 degrees (6.7 degrees). After inflation the mean passive movement was 1.0 +/- 0.07 cm proximal and 4.0 +/- 0.08 cm distal to the tourniquet with a range of 0 degrees to 132 degrees (+/- 7.6 degrees). The ultrasound findings therefore have shown no evidence of restriction of the quadriceps muscle by an inflated tourniquet.