Effect of tranexamic acid in arthroscopic anterior cruciate ligament repair: A systematic review and meta-analysis of randomised clinical trials

Abstract

Purpose: Perioperative blood loss remains a major challenge to surgeons in anterior cruciate ligament reconstruction (ACLR) surgery, despite of the introduction of minimally invasive approach. Tranexamic acid (TXA) is believed to reduce blood loss, which may minimise the complication of postoperative haemarthrosis with insufficient evidence on its effectiveness in ACLR. The primary aim of this study was to examine the effect of TXA on postoperative blood loss and other secondary outcomes in patients undergoing arthroscopic ACLR surgery. Method: PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched from its inception until November 2020. All randomised clinical trials (RCTs) comparing TXA (intravenous or intra-articular) versus placebo in the arthroscopic ACLR surgery were included. Case series, case report and editorials were excluded. Results: Five RCTs comprising of a total of 580 patients (291 in TXA group, 289 in control group) were included for qualitative and quantitative meta-analysis. In comparison to placebo, TXA group was significantly associated with lower postoperative blood loss (mean difference (MD): −81.93 ml; 95% CI −141.80 to −22.05) and lower incidence of needing knee aspiration (odd ratio (OR): 0.19; 95% CI 0.08 to 0.44). Patients who randomised to TXA were also reported to have better range of movement (MD: 2.86; 95% CI 0.54 to 5.18), lower VAS Pain Score (MD: −1.39; 95% CI −2.54 to −0.25) and higher Lysholm Score (MD: 7.38; 95% CI 2.75 to 12.01). Conclusion: In this meta-analysis, TXA reduced postoperative blood loss with lesser incidence of needing knee aspiration along with better range of knee movement and Lysholm score in patients undergoing arthroscopic ACLR surgery.

Ligament Repair Method for Sports Dancers Based on Health Monitoring

“…Tan et al found that despite the introduction of minimally invasive methods, intraoperative bleeding remains a major risk in ligament reconstruction (ACLR) surgery. Through research, it has been analyzed that tranexamic acid (TXA) can effectively solve the problem of bleeding, which can minimize the complications of postoperative hemoarthrosis [ 4 ]. Shu et al presented two cases of posterior cruciate ligament (PCL) repair using suture augmentation (SA) in the setting of multiligamentous knee injuries.…”

Utilization of Tranexamic Acid in Surgical Orthopaedic Practice: Indications and Current Considerations

“… 66 These results are further backed by other studies that have consistently reported decreased postoperative blood loss, decreased incidence of knee aspiration postoperatively, as well as improved pain scores with administration of TXA during ACLR. 67–69 Similar to ACLR, high tibial osteotomies (HTO) carry a risk of hemorrhage given the necessity to expose cancellous bone during the procedure. 70–72 In addition to risk of anemia necessitating blood transfusions, the resulting hemorrhage can potentially lead to the creation of hematomas and thereby delaying postoperative healing.…”

Tranexamic Acid: When is It Indicated in Orthopaedic Surgery?

“…In knee surgery, a recent meta-analysis on anterior cruciate ligament (ACL) reconstruction included 5 RCTs (n = 532) and demonstrated an estimated blood loss of 82 ml (95 % CI 22;142) in favor of TXA [40]. This includes a lower number of postoperative knee aspirations, with an odds ratio of 0.19 (95 % CI 0.08;0.44).…”