Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A.
Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A..
Arthroscopy. 2021 Jun;37(6):1883-1889. doi: 10.1016/j.arthro.2021.01.037. Epub 2021 Jan 30.
The purpose of this double-blind, randomized, controlled trial was to evaluate the use of intravenous (IV) tranexamic acid (TXA) in patients undergoing primary bone-patellar tendon-bone (BPTB) anterior cruciate ligament reconstruction (ACLR) regarding postoperative hemarthrosis, pain, opioid consumption, and quadriceps atrophy and activation.
A controlled, randomized, double-blind trial was conducted in 110 patients who underwent ACLR with BPTB autograft. Patients were equally randomized to the control and experimental groups. The experimental group received two 1-g boluses of IV TXA, one prior to tourniquet inflation and one prior to wound closure; the control group did not receive TXA. If a clinically significant hemarthrosis was evident, the knee was aspirated and the volume of blood (in milliliters) was recorded. Additionally, we recorded perioperative blood loss (in milliliters); visual analog scale scores on postoperative days 1, 4, and 7 and at postoperative weeks 1, 6, and 12; postoperative opioid consumption on postoperative days 1, 4, and 7; range of motion (ROM) and ability to perform a straight leg raise at postoperative weeks 1, 6, and 12; and preoperative and postoperative thigh circumference ratio.
There was no significant difference in perioperative blood loss between the TXA and control groups (32.5 mL vs 35.6 mL, P = .47). In the TXA group, 23 knees were aspirated; in the control group, 26 knees were aspirated (P = .56). No significant difference in postoperative hemarthrosis volume was seen in patients who received IV TXA versus those who did not (26.7 mL vs 37.3 mL, P = .12). There was no significant difference in visual analog scale scores between the 2 groups (P = .15); in addition, there was no difference in postoperative opioid consumption (P = .33). No significant difference in ROM, ability to perform a straight leg raise, or postoperative thigh circumference ratio was observed (P > .05 for all).
IV TXA in patients who undergo ACLR with BPTB autograft does not significantly impact perioperative blood loss, postoperative hemarthrosis, or postoperative pain levels. Additionally, no significant differences were seen in early postoperative recovery regarding ROM or quadriceps reactivation.
Level I, randomized controlled trial.
本双盲、随机、对照试验的目的是评估静脉注射（IV）氨甲环酸（TXA）在接受骨-髌腱-骨（BPTB）前交叉韧带重建（ACLR）的患者中的应用，评估其术后关节血肿、疼痛、阿片类药物消耗以及股四头肌萎缩和激活情况。
对 110 例行 ACLR 联合 BPTB 自体移植物的患者进行了对照、随机、双盲试验。患者被平均随机分为对照组和实验组。实验组在止血带充气前和缝合前各接受 1 次 1 g 的 IV TXA 冲击剂量；对照组未接受 TXA。如果出现明显的关节血肿，则对膝关节进行抽吸，并记录血容量（毫升）。此外，我们还记录围手术期出血量（毫升）；术后第 1、4 和 7 天以及术后第 1、6 和 12 周的视觉模拟评分；术后第 1、4 和 7 天的阿片类药物消耗；术后第 1、6 和 12 周的关节活动度（ROM）和直腿抬高能力；以及术前和术后大腿周径比。
TXA 组和对照组的围手术期出血量无显著差异（32.5 毫升比 35.6 毫升，P=.47）。在 TXA 组中，23 个膝关节进行了抽吸；在对照组中，26 个膝关节进行了抽吸（P=.56）。接受 IV TXA 治疗的患者与未接受治疗的患者的术后关节血肿量无显著差异（26.7 毫升比 37.3 毫升，P=.12）。两组的视觉模拟评分无显著差异（P=.15）；此外，术后阿片类药物消耗也无差异（P=.33）。ROM、直腿抬高能力或术后大腿周径比无显著差异（所有 P 值均＞.05）。
在接受 BPTB 自体移植物 ACLR 的患者中使用 IV TXA 并不会显著影响围手术期出血量、术后关节血肿或术后疼痛水平。此外，在 ROM 或股四头肌再激活方面，早期术后恢复也没有明显差异。
I 级，随机对照试验。
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