Effect of tranexamic acid in arthroscopic anterior cruciate ligament reconstruction:a meta-analysis_West China Medical Journal

Authors：

 LIU Kai , WANG Yongcai , HUANG Qiu , WANG Hongchuan

Department of Orthopedics, People’s Hosipital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

LIU Kai, Email: 285061643@qq.com

Keywords：

Anterior cruciate ligament reconstruction; tranexamic acid; meta-analysis; randomized controlled trial

DOI：

10.7507/1002-0179.202203009

Video：

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Objective To evaluate the efficacy and safety of tranexamic acid in arthroscopic anterior cruciate ligament reconstruction by meta-analysis. Methods The databases searched included Embase, PubMed, Cochrane Library, Wanfang, China National Knowledge Infrastructure and Chongqing VIP. The search time range was from the establishment of the databases to September 2022. All randomized controlled trials using tranexamic acid in arthroscopic anterior cruciate ligament reconstruction were collected. The outcome indicators were postoperative blood loss, postoperative joint cavity puncture rate, postoperative hematoma rate, postoperative Visual Analogue Scale score, and postoperative knee joint range of motion. RevMan 5.3 analysis software was selected for meta-analysis. Results A total of 6 articles were included, including 660 patients. Meta-analysis showed that the postoperative blood loss in the tranexamic acid group was lower than that in the control group [weighted mean difference (WMD)=−24.32 mL, 95% confidence interval (CI) (−33.73 mL, −14.91 mL), P<0.000 01]. The postoperative Visual Analogue Scale score in the tranexamic acid group was lower than that in the control group [WMD=−0.69, 95%CI (−1.21, −0.18), P=0.009]. The postoperative knee joint range of motion in the tranexamic acid group was higher than that in the control group [WMD=2.88°, 95%CI (0.55°, 5.21°), P=0.02]. The postoperative joint cavity puncture rate in the tranexamic acid group was lower than that in the control group [risk ratio (RR)=0.25, 95%CI (0.12, 0.53), P=0.0003]. The postoperative hematoma rate in the tranexamic acid group was lower than that in the control group [RR=0.40, 95%CI (0.21, 0.78), P=0.007]. Conclusion The patients who used tranexamic acid in in arthroscopic anterior cruciate ligament reconstruction have less postoperative bleeding, lower knee joint puncture rate and hematoma formation rate, which are conducive to pain relief and functional rehabilitation.

Citation： LIU Kai, WANG Yongcai, HUANG Qiu, WANG Hongchuan. Effect of tranexamic acid in arthroscopic anterior cruciate ligament reconstruction:a meta-analysis. West China Medical Journal, 2022, 37(10): 1531-1537. doi: 10.7507/1002-0179.202203009 Copy

1.	Lyman S, Koulouvaris P, Sherman S, et al. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am, 2009, 91(10): 2321-2328.
2.	Andrés-Cano P, Godino M, Vides M, et al. Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery. Rev Esp Cir Ortop Traumatol, 2015, 59(3): 157-164.
3.	Bahl V, Goyal A, Jain V, et al. Effect of haemarthrosis on the rehabilitation of anterior cruciate ligament reconstruction-single bundle versus double bundle. J Orthop Surg Res, 2013, 8: 5.
4.	Tzatzairis T, Drosos GI, Vogiatzaki T, et al. Multiple intravenous tranexamic acid doses in total knee arthroplasty without tourniquet: a randomized controlled study. Arch Orthop Trauma Surg, 2019, 139(6): 859-868.
5.	Ma R, Wu M, Li Y, et al. 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. BMC Musculoskelet Disord, 2021, 22(1): 114.
6.	Karaaslan F, Karaoğlu S, Yurdakul E. Reducing intra-articular hemarthrosis after arthroscopic anterior cruciate ligament reconstruction by the administration of intravenous tranexamic acid: a prospective, randomized controlled trial. Am J Sports Med, 2015, 43(11): 2720-2726.
7.	Felli L, Revello S, Burastero G, et al. Single intravenous administration of tranexamic acid in anterior cruciate ligament reconstruction to reduce postoperative hemarthrosis and increase functional outcomes in the early phase of postoperative rehabilitation: a randomized controlled trial. Arthroscopy, 2019, 35(1): 149-157.
8.	Chiang ER, Chen KH, Wang ST, et al. Intra-articular injection of tranexamic acid reduced postoperative hemarthrosis in arthroscopic anterior cruciate ligament reconstruction: a prospective randomized study. Arthroscopy, 2019, 35(7): 2127-2132.
9.	Pande A, Bhaskarwar A. Assessing the effect of per operative intravenous injection of tranexamic acid in patients undergoing arthroscopic anterior cruciate ligament reconstruction Int J Res Orthop, 2019, 5: 639-644.
10.	Lee JW, Kim SG, Kim SH, et al. Intra-articular administration of tranexamic acid has no effect in reducing intra-articular hemarthrosis and postoperative pain after primary ACL reconstruction using a quadruple hamstring graft: a randomized controlled trial. Orthop J Sports Med, 2020, 8(7): 2325967120933135.
11.	邹阿鹏, 李传波, 安丰敏, 等. 关节镜下膝关节前交叉韧带重建术后静脉应用氨甲环酸降低失血量的疗效分析. 实用骨科杂志, 2021, 27(9): 850-852.
12.	Forlenza EM, Parvaresh KC, Cohn MR, et al. Incidence and risk factors for symptomatic venous thromboembolism following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2022, 30(5): 1552-1559.
13.	黄星球, 史成龙, 廖绪强. 氨甲环酸在关节镜下交叉韧带重建术中的应用价值. 中国骨与关节损伤杂志, 2019, 34(6): 622-624.
14.	Teoh WY, Tan TG, Ng KT, et al. Prophylactic topical tranexamic acid versus placebo in surgical patients: a systematic review and meta-analysis. Ann Surg, 2021, 273(4): 676-683.
15.	Small NC. Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy, 1988, 4(3): 215-221.
16.	Belk JW, McCarty EC, Houck DA, et al. Tranexamic acid use in knee and shoulder arthroscopy leads to improved outcomes and fewer hemarthrosis-related complications: a systematic review of level I and II studies. Arthroscopy, 2021, 37(4): 1323-1333.
17.	Parker JD, Lim KS, Kieser DC, et al. Is tranexamic acid toxic to articular cartilage when administered topically? What is the safe dose?. Bone Joint J, 2018, 100-B(3): 404-412.
18.	Montroy J, Hutton B, Moodley P, et al. The efficacy and safety of topical tranexamic acid: a systematic review and meta-analysis. Transfus Med Rev, 2018, 19: S0887-7963(17)30151-7.
19.	Li J, Liu R, Rai S, et al. Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty. J Orthop Surg Res, 2020, 15(1): 581.
20.	Rodriguez-Merchan EC. Does intravenous or intraarticular tranexamic acid (TXA) reduce joint bleeding following arthroscopic anterior cruciate ligament (ACL) reconstruction and arthroscopic meniscectomy? Can intraarticular use be harmful to chondrocytes?. Arch Bone Jt Surg, 2020, 8(5): 557-559.

1. Lyman S, Koulouvaris P, Sherman S, et al. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am, 2009, 91(10): 2321-2328.
2. Andrés-Cano P, Godino M, Vides M, et al. Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery. Rev Esp Cir Ortop Traumatol, 2015, 59(3): 157-164.
3. Bahl V, Goyal A, Jain V, et al. Effect of haemarthrosis on the rehabilitation of anterior cruciate ligament reconstruction-single bundle versus double bundle. J Orthop Surg Res, 2013, 8: 5.
4. Tzatzairis T, Drosos GI, Vogiatzaki T, et al. Multiple intravenous tranexamic acid doses in total knee arthroplasty without tourniquet: a randomized controlled study. Arch Orthop Trauma Surg, 2019, 139(6): 859-868.
5. Ma R, Wu M, Li Y, et al. 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. BMC Musculoskelet Disord, 2021, 22(1): 114.
6. Karaaslan F, Karaoğlu S, Yurdakul E. Reducing intra-articular hemarthrosis after arthroscopic anterior cruciate ligament reconstruction by the administration of intravenous tranexamic acid: a prospective, randomized controlled trial. Am J Sports Med, 2015, 43(11): 2720-2726.
7. Felli L, Revello S, Burastero G, et al. Single intravenous administration of tranexamic acid in anterior cruciate ligament reconstruction to reduce postoperative hemarthrosis and increase functional outcomes in the early phase of postoperative rehabilitation: a randomized controlled trial. Arthroscopy, 2019, 35(1): 149-157.
8. Chiang ER, Chen KH, Wang ST, et al. Intra-articular injection of tranexamic acid reduced postoperative hemarthrosis in arthroscopic anterior cruciate ligament reconstruction: a prospective randomized study. Arthroscopy, 2019, 35(7): 2127-2132.
9. Pande A, Bhaskarwar A. Assessing the effect of per operative intravenous injection of tranexamic acid in patients undergoing arthroscopic anterior cruciate ligament reconstruction Int J Res Orthop, 2019, 5: 639-644.
10. Lee JW, Kim SG, Kim SH, et al. Intra-articular administration of tranexamic acid has no effect in reducing intra-articular hemarthrosis and postoperative pain after primary ACL reconstruction using a quadruple hamstring graft: a randomized controlled trial. Orthop J Sports Med, 2020, 8(7): 2325967120933135.
11. 邹阿鹏, 李传波, 安丰敏, 等. 关节镜下膝关节前交叉韧带重建术后静脉应用氨甲环酸降低失血量的疗效分析. 实用骨科杂志, 2021, 27(9): 850-852.
12. Forlenza EM, Parvaresh KC, Cohn MR, et al. Incidence and risk factors for symptomatic venous thromboembolism following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2022, 30(5): 1552-1559.
13. 黄星球, 史成龙, 廖绪强. 氨甲环酸在关节镜下交叉韧带重建术中的应用价值. 中国骨与关节损伤杂志, 2019, 34(6): 622-624.
14. Teoh WY, Tan TG, Ng KT, et al. Prophylactic topical tranexamic acid versus placebo in surgical patients: a systematic review and meta-analysis. Ann Surg, 2021, 273(4): 676-683.
15. Small NC. Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy, 1988, 4(3): 215-221.
16. Belk JW, McCarty EC, Houck DA, et al. Tranexamic acid use in knee and shoulder arthroscopy leads to improved outcomes and fewer hemarthrosis-related complications: a systematic review of level I and II studies. Arthroscopy, 2021, 37(4): 1323-1333.
17. Parker JD, Lim KS, Kieser DC, et al. Is tranexamic acid toxic to articular cartilage when administered topically? What is the safe dose?. Bone Joint J, 2018, 100-B(3): 404-412.
18. Montroy J, Hutton B, Moodley P, et al. The efficacy and safety of topical tranexamic acid: a systematic review and meta-analysis. Transfus Med Rev, 2018, 19: S0887-7963(17)30151-7.
19. Li J, Liu R, Rai S, et al. Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty. J Orthop Surg Res, 2020, 15(1): 581.
20. Rodriguez-Merchan EC. Does intravenous or intraarticular tranexamic acid (TXA) reduce joint bleeding following arthroscopic anterior cruciate ligament (ACL) reconstruction and arthroscopic meniscectomy? Can intraarticular use be harmful to chondrocytes?. Arch Bone Jt Surg, 2020, 8(5): 557-559.

West China Medical Journal

Effect of tranexamic acid in arthroscopic anterior cruciate ligament reconstruction:a meta-analysis

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