Assessing the effect of per operative intravenous injection of tranexamic acid in patients undergoing arthroscopic anterior cruciate ligament reconstruction

Abstract

<p class="abstract"><strong>Background:</strong> Anterior cruciate ligament (ACL) tear is a common injury sustained during contact games hampering performance of the sportsmen and thus requires promt management. Arthroscopic ACL reconstruction is commonly associated with postoperative knee effusion which affects the functional recovery. Various treatment modalities are available for managing effusion after ACL reconstruction, which are associated with various grades of success and side effects.</p><p class="abstract"><strong>Methods:</strong> This prospective interventional study was carried out at tertiary care Orthopaedic centre. It involved 48 Young male athletes with ACL tear managed subsequently by arthroscopic ACL reconstruction. Subjects were divided into Injection group and non injection group by randomization and blinding was ensured. Postoperative rehabilitation, prophylactic antibiotic and chemoprophylaxis for DVT was kept standardised for all patients. Patients were assessed for pain at operative site by visual analogue scale, effusion of knee by classification of Coupens and Yates and Lysholm knee scoring at 2nd, 6th and 12th week postoperatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> During follow ups it was found that Injection group was having significant less incidence of effusion as compared with Non injection group; which also has reflected in functional recovery.</p><p class="abstract"><strong>Conclusions:</strong> It can be concluded that use of inj tranexamic acid preoperative dose in case of patients undergoing ACL reconstruction is efficient to reduce the knee effusion.</p>

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

“…All the included RCTs reported on the number of patients requiring postoperative knee aspiration. 11,[19][20][21][22] Our pooled data revealed that patients randomised to TXA was associated with lower incidence of needing knee aspiration than the placebo group (studies ¼ 5, patients ¼ 580, OR: 0.19 [95% CI, 0.08 to 0.46], p ¼ 0.0002; I 2 ¼ 0%).…”

“…Four RCTs with a total sample size of 532 patients examined the postoperative blood loss in the arthroscopic ACRL surgery. 11,[19][20][21][22] Our analysis demonstrated that the use of intra-articular or intravenous TXA reduced approximately 80 ml of postoperative blood loss in comparison to the placebo group (MD: À81.93 ml [95% CI À141.80 to À22.05], p ¼ 0.007). However, statistical heterogeneity was observed as substantial (I 2 ¼ 95%).…”

“…The final five included RCTs (a total sample size of 580 patients) were included for qualitative and quantitative analysis. 11,[19][20][21][22] Searching of trial registry identified two ongoing study and one completed study as shown in the Online Supplementary Table 4.…”

“…In term of range of knee movement, patients who received TXA were associated with greater degree of knee movement than the placebo group (studies ¼ 5, patients ¼ 580, MD: 2.86 [95% CI, 0.54 to 5.18]; p ¼ 0.02; I 2 ¼ 0%). 11,[19][20][21][22] The TXA group was also significantly associated with higher Lysholm score as compared to the placebo group (studies ¼ 3, participants ¼ 233, MD: 7.38 [95% CI 2.75 to 12.01], p ¼ 0.002; I 2 ¼ 69%). 11,19,21 Two RCTs (a total number of 405 patients) investigated the use of TXA in the severity of haemarthrosis.…”

“…18 Several recent RCTs investigating the use of intravenous or intra-articular TXA in arthroscopic ACLR surgery were published with conflicting findings. 11,[19][20][21][22] Thus, a systematic review and meta-analysis is warranted to summarise the evidence use of TXA (intravenous or intra-articular) in arthroscopic ACRL surgery before any recommendation is made.…”