Editorial Commentary: Tranexamic Acid Is Beneficial in the Very Early Postoperative Period in Anterior Cruciate Ligament Reconstruction Patients

Chiang, En-Rung; Chen, Kun-Hui; Ma, Hsiao-Li

doi:10.1016/j.arthro.2021.03.016

Cited by 1 publication

(4 citation statements)

References 9 publications

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“…This finding was supported by several randomized controlled trials (RCTs) demonstrating that IV TXA administration protocols could reduce postoperative pain and enhance functional outcomes after ACL reconstruction and meniscectomy 7,28 . A single intra-articular injection of 1 g (100 mg/mL) of TXA was found to considerably reduce postoperative hemarthrosis and pain in the early postoperative period after ACL reconstructions with hamstring grafts 6,10 . However, a double-blinded RCTof patients who underwent ACL reconstruction found no significant differences in perioperative blood loss, postoperative hemarthrosis, or pain levels between those treated with and without IV TXA 29 .…”

Section: Discussionmentioning

confidence: 98%

“…In addition to inconsistent clinical results, safety concerns have been raised regarding the use of TXA in the joint space 10,13,30 . While previous studies have demonstrated the cytotoxicity of TXA, there is a lack of in vivo studies examining the impact of topical use of TXA on intra-articular tissues.…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Chiang et al, intra-articular injection (100 mg/mL) of TXA in patients undergoing ACL reconstruction resulted in decreased pain and a lower grade of hemarthrosis in the early postoperative phase without side effects 6 . However, the safe dose of TXA that can be administered in the knee joint during ACL reconstruction remains unclear, with concerns over potential toxicity to articular cartilage and meniscus 10,[12][13][14] . Tuttle et al observed that 25 mg/mL of TXA had no impact on murine chondrocyte viability, whereas 100 mg/mL resulted in no viable bovine chondrocytes 15 .…”

mentioning

confidence: 99%

“…Some common medical conditions such as renal impairment and cardiovascular diseases may preclude the IV administration of TXA 9 . Additionally, the topical use of TXA is advantageous due to its ease of administration, ability to allow maximum concentration at the bleeding site, and minimal systemic absorption 10,11 . In a study by Chiang et al, intra-articular injection (100 mg/mL) of TXA in patients undergoing ACL reconstruction resulted in decreased pain and a lower grade of hemarthrosis in the early postoperative phase without side effects 6 .…”

mentioning

confidence: 99%

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In Vivo Effect of Single Intra-Articular Injection of Tranexamic Acid on Articular Cartilage and Meniscus

Wang,

Li,

Lin

et al. 2023

Journal of Bone and Joint Surgery

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Background: Tranexamic acid (TXA) has been increasingly used in arthroscopic surgery to prevent hemarthrosis. Despite its effectiveness, safety concerns have been raised regarding its potential cytotoxicity to articular cartilage and meniscus following intra-articular injection. Methods: To evaluate the impact of TXA on cartilage and meniscus, a rat model of knee instability was utilized wherein anterior cruciate ligament (ACL) transection surgery was followed by a single intra-articular injection of TXA at varying concentrations (0, 20, 50, 100, and 150 mg/mL) in saline solution. Cell viability assessment of the cartilage and meniscus (n = 6 per group) was conducted at 24 hours, and gross observation and histological analysis of the medial tibial plateau and medial meniscus were conducted at 2, 4, and 8 weeks (n = 6 per group and time point). Results: The chondrocyte viability was significantly decreased in the 50, 100, and 150 mg/mL TXA groups compared with the specimens injected with saline solution only (saline group) (p = 0.001, p < 0.001, p < 0.001, respectively), as was meniscal cell viability (p = 0.042, p < 0.001, p < 0.001, respectively). At week 8, the saline and 20 and 50 mg/mL groups showed relatively normal appearances, whereas the 100 and 150 mg/mL groups exhibited increased and varying severity of cartilage and meniscal degeneration. In the 150 mg/mL group, the mean Osteoarthritis Research Society International score was significantly higher than that in the saline and 20 mg/mL groups (p = 0.010 and p = 0.007). Additionally, the mean meniscus score in the 150 mg/mL group was significantly higher than that in the saline, 20 mg/mL, and 50 mg/mL groups (p = 0.020, p = 0.021, p = 0.031, respectively). Conclusions: Our findings indicate that concentrations of TXA at or above 100 mg/mL can lead to decreased cell viability in both cartilage and meniscus, resulting in significant cartilage degeneration in rats with ACL transection. Furthermore, the use of 150 mg/mL of TXA led to significant meniscal degeneration. Clinical Relevance: It is prudent to avoid using concentrations of TXA at or above 100 mg/mL for intra-articular injection, as such concentrations may result in adverse effects on the cartilage and meniscus.

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