Effects of tranexamic acid on the recovery of osteochondral defects treated by microfracture and acellular matrix scaffold: an experimental study

Abstract

Background Microfracture and scaffold application in the treatment of osteochondral defects is still one of the most frequently used methods in the clinic. The most important step in this treatment method is the stabilization of fibrin clot. Tranexamic acid (TA) is an antifibrinolytic agent commonly used in orthopedic surgery in recent years. This study evaluated the effect of local TA application on healing of experimentally induced osteochondral defects on rabbits. Methods This paper contains an animal in vivo data and histological outcomes on the effect of TA. Eighteen New Zealand white rabbits were treated unilaterally and cylindrical defects having a width of 4 mm and depth of 5 mm were created in the weight-bearing surfaces of the medial and lateral condyles of the right femur. They were divided into two groups, as group 1 study and group 2 control groups, respectively. One milliliter (ml) of TA was injected into the knee joints of the subjects in group 1. All animals were sacrificed for the extraction of the femur condyles for histologic study at the fourth and eighth weeks after surgery. Histological evaluations were performed by Brittberg and O’Driscoll scores to all samples. Data were organized in a Standard Statistical Package System v.22 software package (SPSS/PC Inc., Chicago, IL.) and reported as mean and median (min-max). Repeated measures ANOVA test was used to compare groups and condyle effects together for each week. p values below 0.05 were considered as statistically significant. Results Samples were taken in the fourth and eighth weeks. The regularity of the surface in group 1 was smoother, and the tissue stability was more robust. Mean Brittberg scores in both weeks were statistically higher in group 1 when compared with group 2. In the microscopic evaluation, it was observed that the regeneration of subchondral and cartilage tissues were more rapid and organized in group 1, and the mean O’ Driscoll scores in both weeks were statistically higher in group 1. Conclusions Application of TA improves the healing time and tissue stability in osteochondral defects which are implanted a-cellular scaffold after microfracture and should be applicable to humans for the treatment of osteochondral defects. Electronic supplementary material The online version of this article (10.1186/s13018-019-1144-7) contains supplementary material, which is available to authorized users.

Safety and Efficacy of Local Tranexamic Acid for the Prevention of Surgical Bleeding in Soft-Tissue Surgery: A Review of the Literature and Recommendations for Plastic Surgery

“…111 In animal models, fibrin glue containing tranexamic acid gave fewer intraabdominal adhesions, 112,113 and topical tranexamic acid reduced healing in tendons 114 but increased healing in fractures. 115,116 The plethora of processes involving plasminogen/ plasmin/urokinase-type plasminogen activator warrants further investigations regarding potential adverse and beneficial effects of topical tranexamic acid.…”

Investigation of the Effects of Intra-articular Tranexamic Acid on Intact Cartilage Tissue and Cartilage Formation in Osteochondral Defects of the Rabbit Knee: An Experimental Study

“…In that study, they found that TXA treatment had no side effects on the final quality of osteochondral reparative tissue but may shorten the modulation to fibrocartilage tissue. In another study, Degirmenci et al evaluated the effect of intra-articular TXA application on the recovery of experimentally induced osteochondral defects in rabbits [ 14 ]. In that study, the rabbits were divided into two groups: Group 1 (study group) and Group 2 (control group).…”

Topical use of tranexamic acid: Are there concerns for cytotoxicity?

“…TXA was supported as a safe drug for topical use in a few studies (Table 1 ). In the study of Degirmenci et al [ 1 ], an in vivo study on experimental animals, TXA seemed to have a significant contribution to the healing of osteochondral defects. This was observed not only macroscopically but also histopathologically, where samples treated with TXA had clearly better recovery than the control groups.…”

“…Tranexamic acid (TXA) is an antifibrinolytic agent and a synthetic derivative of the amino acid lysine, which can inhibit the activation of plasminogen and the fibrin breakdown process[ 1 ]. Plasminogen is a glycoprotein pro-enzyme which is produced in the liver.…”