Administration of Tranexamic Acid to Reduce Intra-articular Hemarthrosis in ACL Reconstruction: A Systematic Review

Single Dose IV Tranexamic Acid is Safe for use in Hip Arthroscopy

PURPOSE

The primary purpose of this study was to determine if TXA is safe to administer preoperatively for patients undergoing hip arthroscopy by comparing the rate of VTE and complications between patients who did and did not receive TXA pre-operatively.

METHODS

This is a multicenter consecutive cohort series of patients that underwent arthroscopic hip surgery from 2014-2021. The two cohorts were patients who did and did not receive TXA preoperatively (single dose of 1-2g) after a practice change. Data was collected via chart review. Surgical outcomes included: days until follow up, Visual Analog Scale (VAS) pain scores at first follow-up, total operating room time, number of arthroscopic fluid bags (3 liters/bag), complications and revision operations up to 1 year after surgery. A Mann-Whitney U test was performed for continuous variables and chi square test for categorical variables.

RESULTS

A total of 862 patients were identified: 449 (52%) did receive TXA and 413 (48%) did not. Patient demographics including age, sex, height, weight, BMI, smoking status, procedures performed, number of anchors used (no TXA: 3.5 anchors; TXA 3.7 anchors), and traction time (no TXA: 38 minutes; TXA: 40 minutes) did not significantly differ between groups. Significantly more patients had a prior hip arthroscopy in the group that received TXA (primary n=404; prior hip arthroscopy n=45) compared to the group that did not receive TXA (primary n=388; prior hip arthroscopy n=25) (p=0.03). VAS pain scores at the first follow up visit (no TXA: 2.61; TXA: 2.62 TXA) (p=0.62) and need for subsequent revision surgery were not significantly different (n=24 no TXA and n=18 TXA) (p=0.68). TXA use was associated with less arthroscopic fluid utilization (no TXA: 5.9 bags of 3L fluid; TXA: 5.3 bags of 3L fluid) (p<0.01) and less total operating room (OR) time (no TXA: 99.5 minutes; TXA: 90.0 minutes) (p<0.01). There was a higher overall complication rate in the no TXA group (n=27) compared to the TXA group (n=10) (p=0.01). However, if lateral femoral cutaneous nerve neuropraxia was excluded, then no difference in complication rate was observed (p=0.24).

CONCLUSIONS

There was no difference in the incidence of VTE complications between patients that did and did not receive TXA preoperatively. We observed a lower overall complication rate in patients who received TXA preoperatively; however, this normalized between the two groups when LFCN neuritis was excluded. No difference in early pain control or revision surgery rates were observed between groups. While there was statistically less arthroscopic fluid utilization and less total OR time in the group that received TXA, further studies are needed to clarify whether this is clinically meaningful. In conclusion, preoperative administration of TXA is a safe adjunct medication for patients undergoing arthroscopic hip surgery.

Tranexamic acid administered intraarticularly to the knee is safer for the articular cartilage and anterior cruciate ligament compared to intravenous administration: Histological analysis of an experimental rat model

In this study, the effects of tranexamic acid (TXA) on the knee's articular cartilage, anterior cruciate ligament (ACL), and joint capsule were assessed histologically. There were 15 rats in each of the 3 groups, totaling 45 rats. Intraarticular (IA) saline injections were applied for the first group, IA TXA injections for the second group, and intravenous (IV) TXA injections for the third group. Using samples taken from the knee joint 3 weeks later, the medial/lateral femoral condyle and medial/lateral tibial plateau articular cartilages were evaluated with Osteoarthritis Research Society International (OARSI) scoring, while ACL diameter and joint capsule thickness were analyzed histologically. In comparisons of OARSI scores for the medial/lateral femoral condyle and medial/lateral tibial plateau cartilage regions, the scores obtained for the IV TXA group were significantly higher than those of the IA saline group (P < 0.001, P = 0.001, P = 0.003, P = 0.011). In comparisons of medial/lateral femoral condyle and medial/lateral tibial plateau OARSI scores, the scores obtained for the IV TXA group were again significantly higher than those of the IA TXA group (P < 0.001, P < 0.001, P < 0.001, P = 0.002). When ACL diameters were compared, a significant decrease was observed in the ACL diameters of the IV TXA group compared to the IA saline and IA TXA groups (P < 0.001, P = 0.039). Histologically, IV TXA damages the articular cartilage and ACL more than IA TXA. IA administration of TXA is more protective when the articular cartilage and ACL are preserved.

Tranexamic acid use in arthroscopic rotator cuff repair is an effective and safe adjunct to improve visualization: a systematic review and meta-analysis

PURPOSE

Although tranexamic acid (TXA) is being increasingly used in orthopedic arthroplasty and lower-extremity arthroscopic procedures, its use in arthroscopic rotator cuff repair (ARCR) is less widely reported. The aim of this study was to evaluate the clinical effectiveness and safety of TXA administration in ARCR.

METHODS

A systematic review and meta-analysis of randomized controlled trials was performed to compare clinical outcomes in patients who underwent ARCR with or without TXA. Literature was retrieved using the Cochrane Library, MEDLINE, PubMed, and Embase electronic databases. The primary outcome of this study was visual clarity. Secondary outcomes contained total operative time, postoperative pain score, amount of blood loss, shoulder swelling (change in shoulder circumference), volume of irrigation fluid, number of adjustments of the pump pressure for irrigation, and adverse cardiovascular events.

RESULTS

Seven studies (3 and 4 with level I and II evidence, respectively), which included 272 and 265 patients who underwent arthroscopy with and without TXA, respectively, met the eligibility criteria. Pooled analysis showed significant improvements in visual clarity (mean difference, 9.10%; 95% CI, 4.05-14.15; P = .0004) and total operative time (mean difference, -11.24 minute; 95% CI, -19.90 to -2.57) associated with perioperative TXA application. None of the trials reported adverse events and complications associated with TXA.

CONCLUSION

The best available evidence indicates that TXA administration could significantly improve arthroscopic visual clarity and effectively save operative time in ARCR without increasing the incidence of adverse events. Furthermore, the optimal dose, route, and timing of TXA application in ARCR surgery remains to be validated by future high-level evidence studies.

Topical administration of tranexamic acid reduces postoperative blood loss and inflammatory response in knee arthroscopic arthrolysis: a retrospective comparative study

BACKGROUND

Knee arthroscopic arthrolysis serves as an effective treatment for knee arthrofibrosis. However, hemarthrosis is the most common complication in arthroscopic surgery, which has potential adverse effects on postoperative rehabilitation. The purpose of this study was to evaluate the effects of topical tranexamic acid (TXA) in knee arthroscopic arthrolysis.

METHODS

A total of 87 patients with knee arthrofibrosis who underwent arthroscopic arthrolysis from September 2019 to June 2021 were eligible for this retrospective review. Patients in the TXA group (n = 47) received topical administration of TXA (50 mL, 10 mg/mL) at the end of the surgery, and patients in the control group (n = 40) received no TXA. The postoperative drainage volumes, hematologic levels, inflammatory marker levels, knee range of motion (ROM), visual analog scale (VAS) pain scores, Lysholm knee scores and complications were compared between the two groups. The curative effect of each group was calculated according to Judet's criteria.

RESULTS

The mean drainage volumes on postoperative day (POD) 1 and POD 2, and total drainage volume were significantly lower in the TXA group than in the control group (P < 0.001 for all). The TXA group had significantly lower postoperative CRP and IL-6 levels on POD 1 and POD 2, and at postoperative week (POW) 1 and POW 2 than the control group. The VAS pain scores in the TXA group were significantly lower on POD 1 and POD 2, and at POW 1 and POW 2 than those in the control group (P < 0.001 for all). Patients in the TXA group showed better postoperative ROM and Lysholm knee scores at POW 1 and POW 2. No patient had any complications such as deep venous thrombosis (DVT) or infection. The excellent and good rates of knee arthroscopic arthrolysis were comparable between the two groups at the sixth postoperative month (P = 0.536).

CONCLUSIONS

Topical administration of TXA in knee arthroscopic arthrolysis can reduce postoperative blood loss and inflammatory response, alleviate early postoperative pain, increase early postoperative knee ROM, and improve early postoperative knee function without increased risks.