Does Tranexamic Acid Reduce Knee Swelling and Improve Early Function Following Arthroscopic Meniscectomy? A Double-Blind Randomized Controlled Trial.

BACKGROUND

Arthroscopic meniscectomy often results in rapid recovery and return to preinjury activities; however, postoperative hemarthrosis and swelling can lead to pain, decreased range of motion, and delayed return to work and leisure activities. Tranexamic acid (TXA) is a lysine-based inhibitor of plasminogen to plasmin that has gained popularity in arthroplasty surgery for reducing blood loss and, more recently, in anterior cruciate ligament reconstruction by reducing postoperative hemarthrosis, swelling, and pain while increasing function in the short term.

PURPOSE

To determine whether there is a role for TXA in improving the short-term results of swelling, pain, and function following arthroscopic meniscectomy.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 2.

METHODS

We performed a prospective double-blinded randomized controlled trial in 41 patients undergoing arthroscopic meniscectomy by comparing patients treated with intravenous TXA with those treated with a placebo (normal saline). A single surgeon treated all patients. Following randomization, a dose of 1 g of TXA in 100 mL of normal saline (treatment group) or 100 mL of normal saline (placebo group) was given intravenously at induction prior to tourniquet inflation by the anesthetist. The anesthetist administering the TXA or placebo was not blinded, but all other clinicians involved were. Patients were evaluated by a blinded observer at postoperative days 3, 14, and 30, with the range of motion, swelling, pain levels (visual analog scale), and Lysholm and Tegner knee scores recorded.

RESULTS

Patient demographics were similar in both groups. In the treatment group, there was a nonsignificant improvement in range of motion ( = .056) and swelling ( = .384) at 14 days; however, there was a significant improvement in the Tegner score at 3 days ( = .0064). The complication profile was similar between the groups.

CONCLUSION

The administration of 1 g of intravenous TXA in routine arthroscopic meniscectomy may improve early functional recovery without increased risk. A larger study is required to confirm these results and further evaluate any potential benefit.

REGISTRATION

ACTRN12618001600235 (Australian New Zealand Clinical Trials Registry).