Tranexamic Acid Has No Effect on Postoperative Hemarthrosis or Pain Control After Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft: A Double-Blind, Randomized, Controlled Trial

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

“…In their article entitled "Tranexamic Acid Has No Effect on Postoperative Hemarthrosis or Pain Control After Anterior Cruciate Ligament Reconstruction Using BoneePatellar TendoneBone Autograft: A Double-Blind, Randomized, Controlled Trial," Fried, Bloom, Hurley, Baron, Popovic, Campbell, Strauss, Jazrawi, and Alaia 9 showed that IV TXA in boneepatellar tendonebone ACL reconstruction has no significant effect on hemarthrosis, pain, opioid and consumption, as well as the thigh circumference ratio. Although they held a different view from some previous reports, we still note that TXA exerts its antifibrinolytic capacity in the early postoperative period: In TXA patients, although not statistically significant, a trend was observed in terms of a better VAS score (postoperative days 1-7) and hemarthrosis rate, as well as less aspirated volume.…”

Editorial Commentary: The Benefits of Tranexamic Acid May Outweigh Risks in Arthroscopy and Sports Medicine

“…We at NYU Langone Health have just completed a Level I, controlled, randomized, double-blinded study assessing intravenous TXA in patients undergoing bone patellar tendon bone autograft ACL reconstruction. 18 These ambulatory surgeries were performed without a postoperative drain. Interestingly, and contrary to what we were expecting, we found no difference in hemarthrosis requiring aspiration, amount of blood aspirated in those requiring it, postoperative thigh circumference or ability to straight leg raise, Visual Analog Scale pain score, opioid consumption, or overall range of motion.…”

Regarding “Tranexamic Acid Has No Effect on Postoperative Hemarthrosis or Pain Control After Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft: A Double-Blind, Randomized, Controlled Trial”

“…We read with great interest and enthusiasm the recently published article titled "Tranexamic Acid Has No Effect on Postoperative Hemarthrosis or Pain Control After Anterior Cruciate Ligament Reconstruction Using BoneePatellar TendoneBone Autograft: A Double-Blind, Randomized, Controlled Trial." 1 Fried et al 1 conducted a randomized controlled trial in which 110 patients undergoing anterior cruciate ligament reconstruction (ACLR) with boneepatellar tendonebone autograft were recruited to receive intravenous (IV) tranexamic acid (TXA) or not to receive it. They found that IV TXA (two 1-g boluses, one before tourniquet inflation and one before wound closure) did not significantly impact perioperative blood loss, postoperative hemarthrosis, pain levels, and recovery.…”

“…Regarding the criterion for aspiration of the knee, Fried et al 1 reported that the knee was aspirated if clinically significant hemarthrosis was evident (Coupens-Yates grade II-IV) or the volume of fluid was believed to be more than 20 mL at the 1-week postoperative assessment. However, this was inconsistent with criteria in previous studies by Felli et al 2 and Karaaslan et al, 3 in which the knee was aspirated in the case of severe pain and persistent and severe hemarthrosis (Coupens-Yates grade IV) and in the case of inadequate flexion on postoperative day 1, respectively.…”

“…As Fried et al 1 reported, perioperative blood loss was documented in the operative note for each patient, whichdto usdseems to be the same as intraoperative blood loss. Actually, in addition to visible intraoperative blood loss and postoperative drainage volume, hidden blood loss (HBL) from bone tunnels and donor sites cannot be neglected.…”