Intraarticular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction
Condition: Anterior Cruciate Ligament Reconstruction
MeSH terms: Hemarthrosis
Study type: Interventional

Summary: 
      Post-anterior cruciate ligament reconstruction (ACLR) hemarthrosis may result in increased
      pain thus delaying postoperative rehabilitation, which may eventually lead to arthrofibrosis
      and a functional deficit. Many antifibrinolytic agents, including tranexamic acid (TXA), have
      been used in orthopedic surgeries to reduce postoperative bleeding.The purpose of this study
      is to evaluate the effect of intra-articular injection of TXA in patients receiving
      arthroscopic ACLRs. Patients were randomized into two groups. Group 1 patients (TXA group)
      received the index procedures with a 10 mL intra-articular injection of TXA. Group 2 (control
      group) patients received the index procedures without TXA injections. An intra-articular
      suction drain was placed recorded 24 h postoperatively. Clinical evaluations using an IKDC
      functional score, range of motion (ROM), and a Visual Analogue Scale (VAS) pain score were
      performed at postoperative day 3 and week 4.
    

Detailed description: 
      TXA group patients received ACLRs and a 10 mL intra-articular injection of TXA after the
      procedure. The control group patients only received ACLRs without TXA injections.
      Randomization was done on the day of the surgery, by an independent investigator who did not
      participate in the surgery, using the permuted block randomization technique.

      The same surgeon treated all patients enrolled in this study. Spinal anesthesia was given to
      all patients and a pneumatic tourniquet was routinely used. In brief, through a 3 cm incision
      over the medial proximal tibia, semitendinosus (ST) and gracilis (Gr) tendons were harvested
      from the distal insertion. Tendons were quadrupled and whip stitched by No. 2 and No. 5
      Ethibond sutures (Ethicon, Somerville, NJ). The diameters of the folded tendons were
      determined by using sizing cylinders with incremental size changes of 0.5 mm.The femoral
      sockets were created at about the 1:30 position (left knee), through the anteromedial portal.
      The tibial tunnel was created with an ACUFEX guide (Smith & Nephew, Andover, MA). The
      diameters of the socket were created in the same manner as the diameter of the folded graft.
      At tibial site, grafts were fixed with bioscrews (BIORCI-HA, Smith & Nephew) at 30 degrees of
      knee flexion. The screw and the tunnel sizes were the same. After completion of the
      procedure, a suction drain (Zimmer HEMOVAC, Warsaw, IN) was placed at the superior lateral
      aspect of the joint. Ten mL of TXA (100 mg/mL) (Daiichi Sankyo, Tokyo, Japan) was injected
      into the joint at the end of the operation and the drain was clamped for 2 h.

      Clinical evaluations The volume of drainage was recorded 24 h after surgery. The grade of
      hemarthrosis, as previously described by Coupens et al.,was also documented at day 3 and week
      The range of knee motion and the IKDC functional score were evaluated 4 weeks post-surgery.
      The VAS was documented at postoperative day 3 and week 4.

      Statistical analysis. All data are expressed as a mean and standard deviation (SD). The
      amount of drainage or functional scores between different groups were compared with an
      independent t test.

      All statistical analyses were conducted using SPSS version 11.0 (SPSS Inc., Chicago,IL).
      Differences were considered significant when the p-value was < 0.05.
    

Intervention name(s): Tranexamic Acid Powder; Post-anterior cruciate ligament reconstruction (ACLR)
Intervention type(s): Drug; Procedure
Intervention description(s): Ten mL of Tranexamic Acid(100 mg/mL) was injected into the joint at the end of the operation.; Post-anterior cruciate ligament reconstruction (ACLR)
Intervention MeSH terms: Tranexamic Acid
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Anterior cruciate ligament reconstruction, knee, hemarthrosis, tranexamic acid