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Intravenous administration of two dose tranexamic acid ( TXA) and local anesthesia (LA) at graft site , improves outcome in single bundle Anatomical Anterior Cruciate Ligament reconstruction in uniformed military personnel.


Mujeeb Ashraf, FRCS, MCh,FEBTS
SAUDI ARABIA

Intravenous administration of two dose tranexamic acid ( TXA) and local anesthesia (LA) at graft site , improves outcome in single bundle Anatomical Anterior Cruciate Ligament reconstruction in uniformed military personnel.

Mujeeb Ashraf, FRCS, MCh,FEBTS, SAUDI ARABIA Abaad saad Al-Thagafi, MBBS, SAUDI ARABIA Hatim Mohammed Alshareef, MD, SAUDI ARABIA Hatem Al-Harbi, FRCSC, SAUDI ARABIA

King Fahad Armed Forces Hospital , Jeddah, Saudi, SAUDI ARABIA

2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Instability

Treatment / Technique

Repair / Reconstruction Arthroscopy Single Bundle

Ligaments

ACL

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Summary: In ACL reconstruction Two dose intravenous tranexamic acid is a safe choice and in combination with Local analgesia at graft site it reduces analgesia requirement , effusion , bruising and improves range of motion.

Introduction

The use of tranexamic acid ( TXA) locally or intravenously is gaining popularity in Orthopaedic surgery. WE performed a prospective randomized controlled trial with combined use of two dose intravenous TXA and local anesthetic ( LA) at graft site during anterior cruciate anatomical reconstruction using accessory anteromedial portal (AAM) .

Methods

A cohort of 130 uniformed military personnel randomly selected through informed consent who had traumatic rupture of ACL requiring reconstruction to receive either TXN + LA combination or only LA without TXN. Exclusion criterion was concomitant ligament injury, meniscal injury requiring repair and clotting disorders. They were divided into a) intravenous TXA + LA combination b ) Only LA groups. All procedures were “Day Surgery” performed by the same surgeon, anatomic placement of quadruple single bundle hamstring graft using the AAM portal technique. 1000 mg of TXA (regardless of weight of the patient) was given intravenously by the anesthetist 15-30 minutes before inflation of the tourniquets and another dose of 1000mg was repeated 15-30 minutes before deflation of the tourniquet. A mixture of Lidocaine 1% and bupivacaine 0.25% instilled along the hamstrings graft site. No post-operative deep vein thrombosis (DVT) prophylaxis used in either groups.
Both the groups had same rehabilitation program selected by the senior author given to patients and to the physiotherapy department. The same surgical team appraised the patients before discharge in “day surgical unit” to evaluate analgesia requirement using Visual Analog Score (VAS) for pain with a varying but uniform set combinations of analgesia and gross Effusion by visual examination only . First post-operative visit at 10-12 days, then 6 weeks and finally 3 ( visit after three months were not included months) .The patents were reviewed in the out-patient clinics using similar protocols and clinical examination techniques for 1) Signs of deep vein thrombosis (DVT) “Well’s criterion” 2) Effusion by “Patellar stroke test”. 3) Bruises by “Harm Score” and 4) Range of motion (degrees) at all the visits.
Results:, Independent sample t-test , Pearson's chi-squared and multivariable logistic regression model were used. We the group receiving combined TXN and LA associated had reduced immediate post-operative effusion and pain leading to less use of narcotics and non-steroidal anti-inflammatory analgesia in recovery room and in take home prescription .Later in the outpatient department this group had less bruising , minimal effusion that translated into better range of motion and minimal use of analgesia . There were no cases of Deep vein thrombosis.(DVT)

Conclusions

This study showed that use of TXA +LA is associated with decrease use of post-operative analgesia ( immediate & late) , decrease haemarthrosis, less bruising , relatively improved early range of motion and no thromboembolic complication.

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