Lamberto Felli1, Stefano Revello1, Giorgio Burastero2, Pietro Gatto1, Antonio Carletti3, Matteo Formica1, Mattia Alessio-Mazzola4. 1. Orthopaedic Clinic, Department of Surgical Sciences, Policlinico San Martino IST, Genoa, Italy. 2. Orthopedic and Traumatology Unit 2, Santa Corona Hospital, Pietra Ligure, Italy. 3. HAN, Anesthesiology Service, Department of Emergency and Acceptance, Policlinico San Martino IST, Genoa, Italy. 4. Orthopaedic Clinic, Department of Surgical Sciences, Policlinico San Martino IST, Genoa, Italy. Electronic address: mattia.alessio@hotmail.com.
Abstract
PURPOSE: To evaluate the effect of tranexamic acid (TXA) in patients undergoing anterior cruciate ligament (ACL) reconstruction in reducing intra-articular effusion and affecting clinical outcomes 3 months after surgery. METHODS:Eighty consecutive patients undergoing ACL reconstruction were prospectively assessed from 2014 to 2016. Patients were randomly allocated to 1 of 2 groups: The test group received an intravenous infusion of 15 mg/kg of TXA, and the control group did not receive TXA. The patellar circumference, range of motion (ROM), Coupens and Yates (CY) value, visual analog scale score for pain assessment, and quadriceps strength (QS) were considered on postoperative day (PD) 1, PD 7, and PD 15 and at 1 month and 3 months after surgery. Blood volume in the intra-articular drainage was recorded on PD 1. Any adverse effect, such as fever onset (>37.5°C), hemarthrosis, or infection, was also considered. RESULTS: We found a statistically significant reduction in drainage blood volume (P < .001) and CY value (P = .0044) on PD 1 in patients in the test group compared with those in the control group. On PD 7, a significant improvement was found for mean CY values (P = .0057), ROM (P = .0031), and QS (P = .015). On PD 15, we noted significant improvements in CY values (P < .001), patellar circumference (P = .0019), QS (P = .0089), and visual analog scale values (P = .0032) in the test group. We noted 13 fever episodes in the control group and 2 fever episodes in the study group (P = .047). No differences for any outcomes or complications were found at 3 months. CONCLUSION:TXA administration reduced hemarthrosis and the amount of suction drainage blood volume, improved ROM and QS, and reduced fever episodes during the first 2 weeks after surgery. TXA use improved early-phase outcomes in the postoperative period after ACL reconstruction. LEVEL OF EVIDENCE: Level I, randomized controlled trial.
RCT Entities:
PURPOSE: To evaluate the effect of tranexamic acid (TXA) in patients undergoing anterior cruciate ligament (ACL) reconstruction in reducing intra-articular effusion and affecting clinical outcomes 3 months after surgery. METHODS: Eighty consecutive patients undergoing ACL reconstruction were prospectively assessed from 2014 to 2016. Patients were randomly allocated to 1 of 2 groups: The test group received an intravenous infusion of 15 mg/kg of TXA, and the control group did not receive TXA. The patellar circumference, range of motion (ROM), Coupens and Yates (CY) value, visual analog scale score for pain assessment, and quadriceps strength (QS) were considered on postoperative day (PD) 1, PD 7, and PD 15 and at 1 month and 3 months after surgery. Blood volume in the intra-articular drainage was recorded on PD 1. Any adverse effect, such as fever onset (>37.5°C), hemarthrosis, or infection, was also considered. RESULTS: We found a statistically significant reduction in drainage blood volume (P < .001) and CY value (P = .0044) on PD 1 in patients in the test group compared with those in the control group. On PD 7, a significant improvement was found for mean CY values (P = .0057), ROM (P = .0031), and QS (P = .015). On PD 15, we noted significant improvements in CY values (P < .001), patellar circumference (P = .0019), QS (P = .0089), and visual analog scale values (P = .0032) in the test group. We noted 13 fever episodes in the control group and 2 fever episodes in the study group (P = .047). No differences for any outcomes or complications were found at 3 months. CONCLUSION:TXA administration reduced hemarthrosis and the amount of suction drainage blood volume, improved ROM and QS, and reduced fever episodes during the first 2 weeks after surgery. TXA use improved early-phase outcomes in the postoperative period after ACL reconstruction. LEVEL OF EVIDENCE: Level I, randomized controlled trial.
Authors: Mary Nugent; Jedediah H May; Jack D Parker; David C Kieser; Michael Douglas; Ron Pereira; Khoon S Lim; Gary J Hooper Journal: Orthop J Sports Med Date: 2019-08-29