การศึกษาเปรียบเทียบประสิทธิภาพในการลดภาวะเลือดออกในข้อเข่าระหว่างกลุ่มที่ได้รับการฉีดเฉพาะ Tranexamic acid กับกลุ่มที่ได้รับการฉีด Tranexamic acid ร่วมกับ Epinephrine เข้าข้อเข่าภายหลังการผ่าตัดส่องกล้องบูรณะเส้นเอ็นไขว้หน้า: การทดลองแบบสุ่มมีกลุ่มควบคุมชนิดปกปิดสองฝ่าย

Athipong Kongrit; Chaloemwut Piyaphattachai; Nopparat Rujiwattanapong; Anugoon Niramitsantiphong; Wattanai Atthakorn

Authors

Athipong Kongrit Department of Orthopaedics, Nakornping Hospital
Chaloemwut Piyaphattachai Department of Orthopaedics, Faculty of Medicine Chiangmai University
Nopparat Rujiwattanapong Department of Orthopaedics, Nakornping Hospital
Anugoon Niramitsantiphong Department of Orthopaedics, Nakornping Hospital
Wattanai Atthakorn Department of Orthopaedics, Nakornping Hospital

Keywords:

anterior cruciate ligament reconstruction, epinephrine, tranexamic acid, intra-articular

Abstract

Introduction: Early postoperative hemarthrosis and knee swelling may occur following arthroscopic anterior cruciate ligament (ACL) reconstruction. The use of epinephrine in combination with tranexamic acid (TXA) may help reduce postoperative hemarthrosis.

Objective: To evaluate the efficacy of intra-articular tranexamic acid alone versus tranexamic acid plus epinephrine in reducing postoperative knee hemarthrosis after arthroscopic anterior cruciate ligament reconstruction in reducing postoperative hemarthrosis.

Methods: A double-blind randomized controlled trial was conducted in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction at Nakornping Hospital between June 21, 2021, and June 20, 2022. Patients were allocated into two groups: the intra-articular TXA group (n = 26) and the intra-articular TXA plus epinephrine group (n = 26). The primary outcome was drain output volume at 24 hours postoperatively. Secondary outcomes included drain output volume at 48 hours, pain intensity assessed using the Visual Analog Scale (VAS), change in hemoglobin level, mid-patellar circumference, knee range of motion, Lysholm score, International Knee Documentation Committee (IKDC) score, hemarthrosis grading, and calf circumference.

Results: The proportions of male patients in the TXA group and the TXA plus epinephrine group were 80.8% and 92.3%, respectively. The mean ages were 30.23 ± 10.99 and 28.61 ± 10.89 years. The most common surgical procedure was ACL reconstruction with meniscus repair (73.08% and 57.69%, respectively). At 24 hours postoperatively, the mean drain output volumes were 90.38 ± 58.27 mL in the TXA group and 65 ± 38.94 mL in the TXA plus epinephrine group (p = 0.123). At 48 hours, the mean drain output volumes were 148.46 ± 83.46 mL and 113.85 ± 60.80 mL, respectively (p = 0.069). The mean VAS scores at 24 hours postoperatively were 6.15 ± 1.43 and 5.23 ± 1.61 (p = 0.034). The increase in mid-patellar circumference at 24 hours was 2.15 ± 0.88 cm and 1.63 ± 0.82 cm, respectively (p = 0.032). No statistically significant differences were observed in other secondary outcomes.

Conclusion: Intra-articular TXA combined with epinephrine following arthroscopic ACL reconstruction tended to reduce postoperative drain output volume; however, the difference was not statistically significant. Further studies are warranted to confirm these findings.

Thai Clinical Trial Registry number TCTR20211124002

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