Johns William L, Walley Kempland C, Hammoud Sommer, Gonzalez Tyler A, Ciccotti Michael G, Patel Nirav K
Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Orthopaedic Surgery, University of Michigan Hospital, Ann Arbor, Michigan, USA.
Am J Sports Med. 2021 Dec;49(14):4030-4041. doi: 10.1177/0363546521988943. Epub 2021 Feb 25.
Hemarthrosis after anterior cruciate ligament (ACL) reconstruction procedures can delay rehabilitation and have toxic effects on the cartilage and synovium. Tranexamic acid is widely used in adult reconstruction procedures; however, its use in ACL reconstruction is a novel topic of study.
To analyze the available literature on hemarthrosis, pain, functional outcomes, and complications after administration of tranexamic acid in ACL reconstruction procedures.
Meta-analysis.
A literature search was performed to retrieve randomized controlled trials examining the use of tranexamic acid at the time of ACL reconstruction procedures. The studied outcomes included postoperative joint drain output, hemarthrosis grade, visual analog scale scores for pain, range of motion, Lysholm score, postoperative rates of deep venous thrombosis, and pulmonary embolism. Outcomes were pooled to perform a meta-analysis.
Five prospective randomized controlled trials met inclusion criteria for analysis. Four studies administered intravenous tranexamic acid in bolus or infusion form before ACL reconstruction, while 2 studies administered tranexamic acid via intra-articular injection. Specifically, tranexamic acid was administered intravenously (preoperative 15-mg/kg bolus 10 minutes before tourniquet inflation with or without 10 mg/kg/h for 3 hours postoperatively) or intra-articularly (10 mL [100 mg/mL] intraoperatively), and 1 study consisted of tranexamic acid administration in combined intravenous and intra-articular forms (15-mg/kg bolus 10 minutes before tourniquet inflation and intra-articular 3 g 10 minutes before tourniquet deflation). Tranexamic acid use in ACL reconstruction cases resulted in a mean reduction of 61.5 mL in postoperative drain output at 24 hours (95% CI, -95.51 to -27.46; = .0004), lower hemarthrosis grade ( < .00001), improved Lysholm scores, and reduction in visual analog scale scores for pain (-1.96 points; 95% CI, -2.19 to -1.73; < .00001) extending to postoperative week 6. Range of motion was improved in the immediate postoperative period, and the need for joint aspiration within 2 weeks was reduced ( < .001). There was no difference in venous thromboembolic event rate between the experimental and control groups.
The use of intravenous tranexamic acid in ACL reconstruction surgery results in reduced joint drain output and hemarthrosis and improved pain scores and range of motion in the initial postoperative period without increased complications or thromboembolic events.
前交叉韧带（ACL）重建术后的关节积血会延迟康复，并对软骨和滑膜产生毒性作用。氨甲环酸广泛应用于成人重建手术；然而，其在ACL重建中的应用是一个新的研究课题。
分析关于氨甲环酸在ACL重建手术中应用后的关节积血、疼痛、功能结局和并发症的现有文献。
荟萃分析。
进行文献检索，以获取研究氨甲环酸在ACL重建手术中应用的随机对照试验。研究的结局包括术后关节引流液量、关节积血分级、疼痛视觉模拟评分、活动范围、Lysholm评分、术后深静脉血栓形成和肺栓塞发生率。汇总结局以进行荟萃分析。
五项前瞻性随机对照试验符合纳入分析标准。四项研究在ACL重建前以推注或输注形式静脉注射氨甲环酸，两项研究通过关节内注射给予氨甲环酸。具体而言，氨甲环酸通过静脉注射（术前10分钟在止血带充气前给予15mg/kg推注，术后3小时有或无10mg/kg/h）或关节内注射（术中10mL[100mg/mL]），一项研究采用静脉和关节内联合给药形式（止血带充气前10分钟给予15mg/kg推注，止血带放气前10分钟关节内注射3g）。在ACL重建病例中使用氨甲环酸导致术后24小时引流液量平均减少61.5mL（95%CI，-95.51至-27.46；P =.0004），关节积血分级降低（P <.00001），Lysholm评分改善，疼痛视觉模拟评分降低（-1.96分；95%CI，-2.19至-1.73；P <.00001），持续至术后第6周。术后即刻活动范围得到改善，2周内关节穿刺的需求减少（P <.001）。实验组和对照组之间静脉血栓栓塞事件发生率无差异。
在ACL重建手术中使用静脉注射氨甲环酸可减少关节引流液量和关节积血，改善术后初期的疼痛评分和活动范围，且不增加并发症或血栓栓塞事件。
