Background
Tranexamic acid (TXA) has been used effectively to decrease blood loss in many fields of surgery. Guidelines for use in arthroscopic surgery are limited to date.
Purpose
To systematically screen the literature in an effort to critically examine the effect of TXA in patients undergoing arthroscopic surgery, specifically pertaining to pain, blood loss, length of surgery, and both major and minor complications.
Study Design: Systematic Review and Meta-Analysis
Methods
In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) guidelines, three databases (MEDLINE, EMBASE, and Cochrane) were searched April 2020 and screened in duplicate using inclusion and exclusion criteria for studies on the given subject. Study findings were reviewed, and meta-analysis was then performed on sufficiently congruent data using a random-effects model.
Results
There were seven eligible randomized controlled trials, with 724 total patients, undergoing ACL reconstruction (4 studies, 537 patients), meniscectomy (1 study, 45 patients), femoroacetabular impingement (1 study, 70 patients), or rotator cuff repair (1 study, 72 patients). The mean age throughout the included studies was 33.9 years, with a mean of 27.7% female patients. There was a 1% drop out rate at 3 months postoperatively. There were significantly lower VAS scores at 2 weeks postoperatively in the TXA groups (Mean difference: -1.65, 95% CI=-3.41 to 0.10, P=0.06, I 2 =97%). Furthermore, there was a significant decrease in the number of patients requiring joint aspiration in the TXA groups (Risk Ratio= 0.27, 95% CI= 0.12 to 0.56, I 2 =0%, p=0.0006). The drainage output in TXA groups was also significantly decreased (Mean difference: -61.14ml, 95% CI= -104.43 to -17.85, I 2 =94%, p=0.006). Furthermore, there was a statistically significant decrease in hemarthrosis grade (Coupens & Yates) at 2 weeks postoperatively (Mean difference: -0.76, 95% CI=-0.97 to -0.54, I 2 =0%, p<0.0001). Finally, there was no significant difference in operating time, across all studies (Mean difference: 0.53, 95% CI=-3.43 to 4.50, I 2 =57%, p<0.79). The use of TXA showed no increased incidence of deep vein thrombosis, infection, arthrofibrosis, or other major complications or adverse reactions between the TXA and control groups.
Conclusions
This systematic review and meta-analysis of RCTs found that the use of TXA significantly improves pain scores up to 6 weeks postoperatively, decreases drainage output, decreases the need for joint aspirations, decreases incidence of hemarthrosis, increases visual clarity and technical ease, and has no increased incidence of other complications, at no loss to operative time. These findings indicate that TXA may be a useful adjunct in arthroscopic surgery, which can be confirmed by larger studies with a wider variety of patients.