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Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study

      Purpose

      To evaluate the effect of intra-articular injection of tranexamic acid (TXA) in patients receiving arthroscopic anterior cruciate ligament reconstruction (ACLR).

      Methods

      A total of 304 patients were included in this study, which was performed between August 2017 and April 2018. Single-bundle reconstructions using autologous hamstring tendon grafts were performed in all patients. Patients were randomized into 2 groups: Group 1 patients (TXA group) received the index procedure with a 10-mL intra-articular injection of TXA (100 mg/mL). Group 2 patients (control group) received the index procedure without TXA injections. An intra-articular suction drain was placed in the joint and clamped for 2 hours after the procedure. The volume of drainage was recorded 24 hours after surgery. Clinical evaluations using the International Knee Documentation Committee functional score, range of motion, and a visual analog scale pain score were performed on day 3 and at week 4 postoperatively.

      Results

      Twenty-four hours after surgery, a significant decrease in the amount of drainage was observed in patients receiving intra-articular injections (TXA group, 56.1 ± 34.1 mL; control group, 80.1 ± 48 mL; P < .05). On day 3 and at week 4, significantly reduced pain scores were reported in the TXA group. However, at week 4, clinical function scores did not show significant differences between the 2 groups.

      Conclusions

      Intra-articular injection of TXA could significantly reduce postoperative intra-articular bleeding in the first 24 hours in patients receiving arthroscopic ACLR. TXA injection may also decrease pain and the grade of hemarthrosis in the early postoperative period. No systemic side effects or need for aspiration was noted during the follow-up period. Therefore, intra-articular injection of TXA could be considered an effective and relatively safe solution to reduce postoperative bleeding and pain in ACLR patients.

      Level of Evidence

      Level II, prospective comparative study.
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      Linked Article

      • Regarding “Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study”
        ArthroscopyVol. 35Issue 11
        • Preview
          We read with great interest the recently published article by Chiang et al.1 on the use of tranexamic acid (TXA) in arthroscopic anterior cruciate ligament (ACL) reconstruction. Previously, the drug had been successfully used to control bleeding and reduce total blood loss in non-orthopaedic procedures2,3; more recently, several high-quality studies have addressed the use of TXA in joint replacement, and its efficacy in this setting is now widely recognized.4-6 The benefits of TXA should be studied for other orthopaedic procedures that may take advantage of reduced bleeding, such as closed-joint surgery, in which hemarthrosis is a cause of pain, functional limitation, and difficulty in rehabilitation.
        • Full-Text
        • PDF
      • The Dangers and Concerns of Intra-articular Tranexamic Acid
        ArthroscopyVol. 35Issue 11
        • Preview
          I read with interest the article from Chiang et al.1 entitled “Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study.” The authors have done an excellent job of reporting their results and findings. After completion of the study, they concluded that “intra-articular injection of TXA [tranexamic acid] could be considered an effective and relatively safe solution to reduce postoperative bleeding.” This conclusion is based on measurements of postoperative drainage and a 4-week follow-up evaluation of pain.
        • Full-Text
        • PDF
      • Editorial Commentary: Tranexamic Acid: Okay, It Reduces the Bleeding, but Are We Sure Topical Use Is Not Harmful to the Cartilage?
        ArthroscopyVol. 35Issue 7
        • Preview
          Numerous studies have estimated the role of hemarthrosis and intra-articular drains in anterior cruciate ligament (ACL) reconstructive procedures. Long-standing hemarthrosis and related pain can disrupt rehabilitation and lead to arthrofibrosis. A significant number of orthopaedic surgeons use intra-articular suction drains following arthroscopic ACL reconstruction. Hemarthrosis and pain have undesirable effects on the functional outcomes of ACL reconstruction in the early postoperative period.
        • Full-Text
        • PDF