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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Article info
Publication history
Published online: June 18, 2019
Accepted:
February 8,
2019
Received:
September 16,
2018
Footnotes
See commentary on page 2133
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America
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- Regarding “Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study”ArthroscopyVol. 35Issue 11
- PreviewWe 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
- Preview
- The Dangers and Concerns of Intra-articular Tranexamic AcidArthroscopyVol. 35Issue 11
- PreviewI 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
- Preview
- Editorial Commentary: Tranexamic Acid: Okay, It Reduces the Bleeding, but Are We Sure Topical Use Is Not Harmful to the Cartilage?ArthroscopyVol. 35Issue 7
- PreviewNumerous 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
- Preview
