The pneumatic tourniquet has been used in extremity surgery, especially in knee surgery. Both advantages and disadvantages were reported for using this co-operative instrument. The advantages, such as improving the surgical field and decreasing the blood loss were significant, however, disadvantages—such as increasing risk of deep vein thrombosis (DVT), nerve and muscle injuries—made its use controversial. In this review we evaluated the impact of the tourniquet on knee surgery, briefly focusing on its advantages and disadvantages in order to offer surgeons a more reliable guidelines. In previous studies there were several limitations in methodological design, tourniquet identifications, and post-operative anticoagulant regime, which made the results unreliable. Limitations such as not considering blinding assessors, assessing results with intention to treat principles, justification of sample size on the basis of power calculation and described cohort study were the most common problems in methodological designs. Lack of notification in assessing quality of life in tourniquet-used patients was a major problem which needs to be further evaluated. So we recommended designing a study that would preclude the aforementioned limitations.