Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study

Chiang, En Rung; Chen, Kun Hui; Wang, Shih Tien; Li, Hsiao; Chang, Ming Chau; Liu, Chien Lin; Chen, Tain Hsiung

doi:10.1016/j.arthro.2019.02.018

Cited by 56 publications

(122 citation statements)

References 23 publications

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“…Intra-articular injection of TXA can be quickly absorbed locally; the physiological half-life of TXA in the joint cavity is approximately 3 hours [23], thus local hemostasis can be achieved. To date, there has been only one study on intraarticular injection of TXA to reduce intra-articular hemarthrosis after ACLR [11], and the results of that study were similar to ours. The confusion of intra-articular injection of TXA after ACLR was that it was unclear whether TXA could harm the knee environment, particularly by potentially causing apoptosis of chondrocytes and tenocytes.…”

Section: Discussionsupporting

confidence: 85%

“…There are many administration routes for TXA, including intravenous administration, intra-articular injection, intramuscular injection and oral administration, among which intravenous administration and intraarticular injection are more commonly used in orthopedic applications [17]. Both intravenous and intraarticular applications of TXA have been reported to reduce drainage blood volume and hemarthrosis after ACLR, thereby reducing joint pain and swelling and promoting joint function recovery [9][10][11]18]. To the best of our knowledge, no study has compared the e cacies of intravenous administration and intraarticular injection of TXA in reducing postoperative hemarthrosis after ACLR.…”

Section: Discussionmentioning

confidence: 99%

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The Comparative Efficacies of Intravenous Administration And Intra-Articular Injection of Tranexamic Acid During Anterior Cruciate Ligament Reconstruction For Reducing Postoperative Hemarthrosis: A Prospective Randomized Study

et al. 2020

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Background: Hemarthrosis after anterior cruciate ligament (ACL) reconstruction can create many adverse joint effects. Tranexamic acid (TXA) can be used to minimize hemarthrosis and associated pain after ACL reconstruction. We aimed to compare the efficacies of intravenous (IV) administration and intra-articular (IA) injection of TXA during ACL reconstruction for reducing postoperative hemarthrosis.Methods: A total of 120 patients who underwent arthroscopic ACL reconstruction were included in this prospective and randomized study. All patients were randomized into three groups: IV group, IA group and placebo group. Patients in the IV group received intravenously administered TXA (15 mg/kg in 100 mL of saline solution) 10 minutes before tourniquet release; patients in the IA group received intra-articular TXA (15 mg/kg in 100 mL of saline solution) injected via the drainage tube; and patients in the placebo group received an equivalent volume of normal saline administered into the knee joint cavity and intravenously. Drainage tubes were removed 24 hours after surgery, and all enrolled patients experienced a 4-week follow-up period. The drain output volume, visual analogue scale (VAS) score, patellar circumference, hemarthrosis grade and Lysholm score of all patients were recorded.Results: Both the IV group and the IA group had significantly lower drain output volumes at day 1, lower VAS scores at weeks 1 and 2, smaller patellar circumferences at weeks 1 and 2, and lower hemarthrosis grades at weeks 1 and 2 than the placebo group. There were no significant differences in drain output volume, VAS score, patellar circumference or hemarthrosis grade between the IV group and the IA group at any time point. No obvious differences in Lysholm score were observed between any pair of groups at week 4. Neither infection nor deep vein thrombosis occurred in any group.Conclusions: Both intravenous administration and intra-articular injection can reduce intra-articular hemarthrosis, joint pain and swelling. No significant difference in the efficacies of reducing hemarthrosis, joint pain and swelling was found between intravenous administration and intra-articular injection.Trial registration: The study was registered by the Chinese Clinical Trial Registry (The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction; ChiCTR-INR-17012217; August 1, 2017)

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

The Comparative Efficacies of Intravenous Administration And Intra-Articular Injection of Tranexamic Acid During Anterior Cruciate Ligament Reconstruction For Reducing Postoperative Hemarthrosis: A Prospective Randomized Study

et al. 2020

Preprint

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show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

“…Some studies reported that IV administration of TXA could reduce the amount of drainage blood and postoperative hemarthrosis, reduce fever episodes and the need for aspiration of the knee, and improve knee range of motion (ROM) and early-phase outcomes without side effects after ACL reconstruction [9,10]. Research on intra-articular injection of TXA during ACLR reported that it could signi cantly reduce postoperative intra-articular bleeding, pain and the grade of hemarthrosis, and no systemic side effects or need for aspiration was noted during the follow-up period [11]. However, the comparative e cacies of IV and IA TXA for reducing postoperative hemarthrosis during ACLR remain elusive.…”

Section: Introductionmentioning

confidence: 99%

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The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction for reducing postoperative hemarthrosis

Ma¹,

Wu²,

Li³

et al. 2020

Preprint

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Background Hemarthrosis after anterior cruciate ligament (ACL) reconstruction can create many adverse joint effects. Tranexamic acid (TXA) can be used to minimize hemarthrosis and associated pain after ACL reconstruction. We aimed to compare the efficacies of intravenous (IV) administration and intra-articular (IA) injection of TXA during ACL reconstruction for reducing postoperative hemarthrosis. Methods A total of 120 patients who underwent arthroscopic ACL reconstruction were included in this prospective and randomized study. All patients were randomized into three groups: IV group, IA group and placebo group. Patients in the IV group received intravenously administered TXA (15 mg/kg in 100 mL of saline solution) 10 minutes before tourniquet release; patients in the IA group received intra-articular TXA (15 mg/kg in 100 mL of saline solution) injected via the drainage tube; and patients in the placebo group received an equivalent volume of normal saline administered into the knee joint cavity and intravenously. Drainage tubes were removed 24 hours after surgery, and all enrolled patients experienced a 4-week follow-up period. The drain output volume, visual analogue scale (VAS) score, patellar circumference, hemarthrosis grade and Lysholm score of all patients were recorded. Results Both the IV group and the IA group had significantly lower drain output volumes at day 1, lower VAS scores at weeks 1 and 2, smaller patellar circumferences at weeks 1 and 2, and lower hemarthrosis grades at weeks 1 and 2 than the placebo group. There were no significant differences in drain output volume, VAS score, patellar circumference or hemarthrosis grade between the IV group and the IA group at any time point. No obvious differences in Lysholm score were observed between any pair of groups at week 4. Neither infection nor deep vein thrombosis occurred in any group. Conclusion Both intravenous administration and intra-articular injection can reduce intra-articular hemarthrosis, joint pain and swelling. No significant difference in the efficacies of reducing hemarthrosis, joint pain and swelling was found between intravenous administration and intra-articular injection. Trial registration: The study was registered by the Chinese Clinical Trial Registry (ChiCTR-INR-17012217, 1 August 2017)

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Surgical Techniques and Protocols to Minimize Blood Loss and Postoperative Pain

Heckmann

Sporer

2023

Outpatient Hip and Knee Replacement

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Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study

Cited by 56 publications

References 23 publications

The Comparative Efficacies of Intravenous Administration And Intra-Articular Injection of Tranexamic Acid During Anterior Cruciate Ligament Reconstruction For Reducing Postoperative Hemarthrosis: A Prospective Randomized Study

The Comparative Efficacies of Intravenous Administration And Intra-Articular Injection of Tranexamic Acid During Anterior Cruciate Ligament Reconstruction For Reducing Postoperative Hemarthrosis: A Prospective Randomized Study

The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction for reducing postoperative hemarthrosis

Surgical Techniques and Protocols to Minimize Blood Loss and Postoperative Pain

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