To systematically review the literature to compare the efficacy and safety of tranexamic acid (TXA) as a means to minimize hemarthrosis-related complications following arthroscopic procedures of the knee, hip, and shoulder.
A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed by searching the PubMed, Cochrane Library, and Embase databases to locate randomized controlled trials comparing the clinical outcomes and postoperative complications of patients undergoing arthroscopy with and without TXA. Search terms used were “tranexamic acid,” “arthroscopy”, “knee”, “hip”, and “shoulder.” Patients were evaluated based on early (<6 weeks) postoperative signs of hemarthrosis using the Coupens and Yates classification, postoperative complications (myocardial infarction, stroke, venous thromboembolism events), range of motion (ROM), and patient-reported outcome scores (Visual Analog Scale, Subjective International Knee Documentation Committee, Lysholm, and Tegner activity scores).
Five studies (2 Level I, 3 Level II) met inclusion criteria, including a total of 299 patients undergoing arthroscopy with TXA and 299 patients without TXA. The average follow-up duration for all patients was 43.9 days. Procedures performed were partial meniscectomy(1), anterior cruciate ligament reconstruction(3), and rotator cuff repair(1). No studies evaluating TXA use in hip arthroscopy were identified. Coupens-Yates hemarthrosis grades significantly improved in the TXA groups across all studies. Three studies found TXA patients to experience significantly less postoperative pain at latest follow-up, one study found TXA patients to have significantly better postoperative Lysholm scores, and one study found TXA patients to have significantly more ROM at latest follow-up when compared to non-TXA patients (p < 0.05).
Patients undergoing arthroscopy, particularly arthroscopic meniscectomy, arthroscopic-assisted anterior cruciate ligament reconstruction, and arthroscopic rotator cuff repair, with TXA can be expected to experience improved outcomes and less hemarthrosis-related complications in the early postoperative period when compared to non-TXA patients.

Copyright © 2020. Published by Elsevier Inc.