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Purpose Aim of this systematic review was to evaluate the literature regarding the efect of tranexamic acid (TXA) on the outcome after knee osteotomy. Methods A systematic literature search was carried out in various databases on studies on the use of tranexamic acid in osteotomies around the knee. Primary outcome criterion was the hemoglobin (drop). Secondary outcome criteria were total blood loss, drainage volume, adverse efects such as thromboembolic events, blood transfusions, wound complications and clinical scores. A meta-analysis was performed for quantitative measures. The present study was registered prospectively (www. crd. york. ac. uk/ PROSP ERO; no.: CRD42021229624). Results Seven studies with 584 patients (TXA group: 282 patients, non TXA group: 302 patients) Hemoglobin decrease (1.54 g/dl vs. 2.28 g/dl), blood loss (394.49 ml vs. 595.54 ml) and drainage volume (266.5 ml vs. 359.05 ml) were signiicantly less in the TXA group compared to the non TXA group. No thromboembolic event was noted in any study. In the non TXA group four blood transfusions were given. Eleven wound complications occurred in the non TXA group in comparison to two wound complications in the TXA group. ConclusionsThe results of the present study show that the application of TXA reduces hemoglobin drop, blood loss and drainage volume. These efects could be responsible for the lesser rate of side efects after administration of TXA during knee osteotomy. KeywordsHigh tibial osteotomy • Medial open wedge osteotomy • Distal femoral osteotomy • HTO • DFO • Osteotomy and tranexamic acid * Wolf Petersen

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