The Effect of Initial Graft Tension After Anterior Cruciate Ligament Reconstruction

Background: The initial graft tension applied at the time of anterior cruciate ligament (ACL) reconstruction alters joint contact and may influence cartilage health. The objective was to compare outcomes between 2 commonly used “laxity-based” initial graft tension protocols. Hypotheses: (1) The high-tension group would have less knee laxity, improved clinical and patient-oriented outcomes, and less cartilage damage than would the low-tension group after 36 months of healing. (2) The outcomes of the high-tension group would be equivalent to those of a matched control group. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Ninety patients with isolated unilateral ACL injuries were randomized to undergo ACL reconstruction using 1 of 2 initial graft tension protocols: (1) autografts tensioned to restore normal anterior-posterior (AP) laxity at the time of surgery (ie, low tension; n = 46) and (2) autografts tensioned to overconstrain AP laxity by 2 mm (ie, high tension; n = 44). Sixty matched healthy patients formed the control group. Outcomes were assessed preoperatively, intraoperatively, and at 6, 12, and 36 months after surgery. Results: No significant differences were found between the 2 initial graft tension protocols for any of the outcome measures at 36 months. However, there were differences when comparing the 2 treatment groups to the control group. On average, AP laxity was 2 mm greater in the ACL-reconstructed groups than in the control group ( P < .007). International Knee Documentation Committee (IKDC) knee evaluation scores, peak isokinetic knee extension torques, and 4 of 5 Knee Osteoarthritis Outcome Scores (KOOS) were significantly worse than the control group ( P < .001, P < .027, and P < .05, respectively). Short Form–36 Health Survey (SF-36) scores and reinjury rates were similar between groups at 36 months. Although there were significant changes in radiography and magnetic resonance imaging present in the ACL-reconstructed knees of both treatment groups, the magnitude was relatively small and likely clinically insignificant at 36 months. Conclusion: Both laxity-based initial graft tension protocols produced similar outcomes without fully restoring joint function or patient-oriented outcomes (KOOS) when compared with the control group. There was minimal evidence of cartilage damage 36 months after surgery.

Download Full-text

Evaluation of Graft Tensioning Effects in Anterior Cruciate Ligament Reconstruction between Hamstring and Bone–Patellar Tendon Bone Autografts

The Journal of Knee Surgery ◽

10.1055/s-0039-3402046 ◽

2020 ◽

Cited By ~ 3

Author(s):

Steven F. DeFroda ◽

Naga Padmini Karamchedu ◽

Ross Budacki ◽

Taylor Wiley ◽

Paul D. Fadale ◽

...

Keyword(s):

Mental Health ◽

Anterior Cruciate Ligament ◽

Social Functioning ◽

Cruciate Ligament ◽

Bodily Pain ◽

Graft Tension ◽

High Tension ◽

Sf 36 ◽

Anterior Cruciate ◽

Low Tension

AbstractThis article investigates the clinical, functional, and radiographic outcomes in anterior cruciate ligament (ACL) reconstruction patients over 7 years to determine the effects of initial graft tension on outcomes when using patellar tendon (bone–tendon–bone [BTB]) and hamstring tendon (HS) autografts. Ninety patients, reconstructed with BTB or HS, were randomized using two initial graft tension protocols: (1) normal anteroposterior (AP) laxity (“low-tension”; n = 46) and (2) AP laxity overconstrained by 2 mm (“high-tension”; n = 44). Seventy-two patients had data available at 7 years, with 9 excluded for graft failure. Outcomes included the Knee Injury and Osteoarthritis Outcome Score, Short-Form-36 (SF-36), and Tegner activity scale. Clinical outcomes included KT-1000S and International Knee Documentation Committee examination score; and functional outcomes included 1-leg hop distance and peak knee extensor torque. Imaging outcomes included medial joint space width, Osteoarthritis Research Society International radiographic score, and Whole-Organ Magnetic Resonance Score. There were significantly improved outcomes in the high-tension compared with the low-tension HS group for SF-36 subset scores for bodily pain (p = 0.012), social functioning (p = 0.004), and mental health (p = 0.014) 84 months postsurgery. No significant differences in any outcome were found within the BTB groups. Tegner activity scores were also significantly higher for the high-tension HS group compared with the low-tension (6.0 vs. 3.8, p = 0.016). Patients with HS autografts placed in high tension had better outcomes relative to low tension for Tegner activity score and SF-36 subset scores for bodily pain, social functioning, and mental health. For this reason, we recommend that graft fixation be performed with the knee at 30-degree flexion (“high-tension” condition) when reconstructing the ACL with HS autograft.

Download Full-text

Effect of Matching or Overconstraining Knee Laxity During Anterior Cruciate Ligament Reconstruction on Knee Osteoarthritis and Clinical Outcomes

The American Journal of Sports Medicine ◽

10.1177/0363546516638387 ◽

2016 ◽

Vol 44 (7) ◽

pp. 1660-1670 ◽

Cited By ~ 16

Author(s):

Matthew R. Akelman ◽

Paul D. Fadale ◽

Michael J. Hulstyn ◽

Robert M. Shalvoy ◽

Arlene Garcia ◽

...

Keyword(s):

Cruciate Ligament ◽

Knee Laxity ◽

Control Group ◽

Graft Tension ◽

High Tension ◽

Sf 36 ◽

Radiographic Score ◽

Patient Reported ◽

Anterior Cruciate ◽

Low Tension

Background: The “initial graft tension” applied at the time of graft fixation during anterior cruciate ligament (ACL) reconstruction surgery modulates joint contact mechanics, which in turn may promote posttraumatic osteoarthritis (OA). Purpose/Hypotheses: The study objectives were to compare clinical, functional, patient-reported, and OA imaging outcomes between 2 different initial laxity-based graft tension cohorts and a matched uninjured control group as well as to evaluate the effects of laxity-based graft tension on OA development at 84-month follow-up. The 2 laxity-based tension protocols were (1) to restore normal anteroposterior (AP) laxity at the time of surgery relative to the contralateral uninjured knee (low-tension group) or (2) to overconstrain AP laxity by 2 mm relative to the contralateral uninjured knee (high-tension group). The hypotheses were that (1) the high-tension group would have improved outcomes and decreased OA compared with the low-tension group after 84 months, and (2) the outcomes for the high-tension group would be equivalent to those for an age-, sex-, race-, and activity-matched group of control participants with uninjured knees. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients had their ACLs reconstructed with either a bone–patellar tendon–bone or 4-stranded hamstring autograft, and outcomes were compared with a matched control group. Outcomes were evaluated preoperatively and at 60 and 84 months postoperatively and included clinical (KT-1000 arthrometer AP laxity measurement and International Knee Documentation Committee [IKDC] examination score), functional (1-legged hop for distance and knee extensor torque), patient-reported (Knee injury and Osteoarthritis Outcome Score [KOOS], Short Form–36 [SF-36], and patient satisfaction survey), and OA imaging (measurement of joint space width [JSW], Osteoarthritis Research Society International [OARSI] radiographic score, and Whole-Organ Magnetic Resonance Imaging Score [WORMS]) components. Repeated-measures analyses of variance were used to evaluate differences in outcomes between the treatment groups and the control group. Results: There were significant differences between the 2 tension groups in 1 of 5 KOOS subscales (sports and recreation; P = .04) and 2 of 8 SF-36 subscales (vitality, mental health; P < .04) at 84 and 60 months, respectively. Both tension groups scored significantly worse than the control group in the IKDC examination ( P < .001), 1-legged hop ( P ≤ .017), KOOS quality of life and symptoms subscales ( P < .03), and OARSI radiographic score ( P ≤ .02) at 84 months. The low-tension group performed significantly worse than the control group on the KOOS pain subscale ( P = .03), SF-36 general health and social functioning ( P < .04), OARSI radiographic score ( P < .001), and WORMS ( P = .001), while the high-tension group had statistically different results than the control group in AP knee laxity ( P < .001), radiographic JSW ( P = .003), and OARSI radiographic score ( P = .02) as well as significantly more subsequent knee injuries ( P = .02) at 84 months. Conclusion: The results do not support the hypotheses that the high-tension group would have improved outcomes when compared with the low-tension group after 84 months of healing or that the outcomes for the high-tension group would be equivalent to those for the matched control group. While there were minor differences in patient-reported outcomes between the 2 laxity-based tension groups, all other outcomes were similar. Registration: NCT00434837

Download Full-text

Comparison of the Position-Matching and Position-Reproducing Tasks to Detect Deficits in Knee Position Sense After Reconstruction of the Anterior Cruciate Ligament

Journal of Sport Rehabilitation ◽

10.1123/jsr.2017-0275 ◽

2020 ◽

Vol 29 (1) ◽

pp. 87-92

Author(s):

Takuma Hoshiba ◽

Hiroki Nakata ◽

Yasuaki Saho ◽

Kazuyuki Kanosue ◽

Toru Fukubayashi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Sport Participation ◽

Cruciate Ligament ◽

Knee Extension ◽

Position Sense ◽

Matching Task ◽

Control Group ◽

Knee Position ◽

Anterior Cruciate

Context: Deficits in knee position sense following reconstruction of the anterior cruciate ligament (ACL) can delay an athlete’s return to sport participation and increase the risk of reinjury. Deficits in position sense postreconstruction have been evaluated using either a position-reproducing or position-matching task. Objective: The aim of our study was to combine both to determine which assessment would be more effective to identify deficits in knee position sense. Design: Longitudinal laboratory-based study. Participants: Eleven athletes (6 men and 5 women; mean age, 20.5 [1.2] y), who had undergone ACL reconstruction with an ipsilateral hamstring autograft, and 12 age-matched controls. Interventions: Position sense was evaluated at 6 and 12 months postreconstruction and once for the control group. In addition, peak isokinetic knee extension and flexion strength, at 60°/s and 180°/s, was assessed for the ACL reconstruction group to evaluate possible influences of muscle strength on knee joint position sense. Main Outcome Measures: The variables include the angular differences between the reference limb and indicator limb, and peak torque values of isokinetic knee extension and flexion. Results: Significant matching differences were identified at 6 months postsurgery on the position-matching task, but not at 12 months postsurgery. No significant between-group and within-subject differences were identified on the position-reproducing task. No significant matching errors were identified for the control group. There was no correlation between errors in position sense and maximum isokinetic strength. Conclusion: The position-matching task is more sensitive than the position-reproducing task to identify deficits in knee position sense over the first year following ACL reconstruction surgery.

Download Full-text

Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0837.r1 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 285-293 ◽

Cited By ~ 6

Author(s):

A. Nakamae ◽

N. Adachi ◽

M. Deie ◽

M. Ishikawa ◽

T. Nakasa ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Articular Cartilage ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Cartilage Damage ◽

Significant Risk ◽

Articular Cartilage Damage ◽

Anterior Cruciate

Aims To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction. Patients and Methods A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage. Results In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors. Conclusion Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285–93.

Download Full-text

Gait Analysis and Knee Kinematics in Patients with Anterior Cruciate Ligament Rupture: Before and After Reconstruction

Applied Sciences ◽

10.3390/app10103378 ◽

2020 ◽

Vol 10 (10) ◽

pp. 3378

Author(s):

Dmitry Skvortsov ◽

Sergey Kaurkin ◽

Alexander Akhpashev ◽

Aljona Altukhova ◽

Alexander Troitskiy ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Gait Analysis ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Surgical Reconstruction ◽

Control Group ◽

Cycle Duration ◽

Post Surgery ◽

Before And After ◽

Anterior Cruciate

The objective of the study was to evaluate the clinical, functional, and biomechanical symptoms in patients with anterior cruciate ligament (ACL) rupture before and after ACL reconstruction. The study enrolled 20 patients and 20 healthy subjects as controls. Walking biomechanics was assessed at three time points: before surgery and three months and a year or more after surgical reconstruction. Impact loads on both sides differed significantly from the respective values before surgery (p<0.05). Walking cycle duration decreased with time after surgery. On both sides (affected and unaffected), hip movement amplitudes were significantly smaller than in control (p<0.05). They remained so in the follow-up periods after the reconstruction. Before ACL reconstruction, the amplitude of the main flexion of the knee was significantly reduced both on the affected and unaffected sides. The amplitude gradually increased after the reconstruction, and a year post-surgery, it reached, on the operated side, the same values as in the control group. Complete functional recovery of the knee joint was not achieved within a year after the ACL surgical reconstruction. The remaining changes, however, were not clinically pronounced and could only be detected by instrumental gait analysis. The compensatory processes developed bilaterally, in both the hip and knee joints.

Download Full-text

Mesenchymal stromal cells and platelet-rich plasma promote tendon allograft healing in ovine anterior cruciate ligament reconstruction

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06392-9 ◽

2020 ◽

Author(s):

Adam T. Hexter ◽

Anita Sanghani-Kerai ◽

Nima Heidari ◽

Deepak M. Kalaskar ◽

Ashleigh Boyd ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Stromal Cells ◽

Femoral Tunnel ◽

Platelet Rich Plasma ◽

Cruciate Ligament ◽

Control Group ◽

Tendon Allograft ◽

Tunnel Diameter ◽

Anterior Cruciate

Abstract Purpose The effect of bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) on tendon allograft maturation in a large animal anterior cruciate ligament (ACL) reconstruction model was reported for the first time. It was hypothesised that compared with non-augmented ACL reconstruction, BMSCs and PRP would enhance graft maturation after 12 weeks and this would be detected using magnetic resonance imaging (MRI). Methods Fifteen sheep underwent unilateral tendon allograft ACL reconstruction using aperture fixation and were randomised into three groups (n = 5). Group 1 received 10 million allogeneic BMSCs in 2 ml fibrin sealant; Group 2 received 12 ml PRP in a plasma clot injected into the graft and bone tunnels; and Group 3 (control) received no adjunctive treatment. At autopsy at 12 weeks, a graft maturation score was determined by the sum for graft integrity, synovial coverage and vascularisation, graft thickness and apparent tension, and synovial sealing at tunnel apertures. MRI analysis (n = 2 animals per group) of the signal–noise quotient (SNQ) and fibrous interzone (FIZ) was used to evaluate intra-articular graft maturation and tendon–bone healing, respectively. Spearman’s rank correlation coefficient (r) of SNQ, autopsy graft maturation score and bone tunnel diameter were analysed. Results The BMSC group (p = 0.01) and PRP group (p = 0.03) had a significantly higher graft maturation score compared with the control group. The BMSC group scored significantly higher for synovial sealing at tunnel apertures (p = 0.03) compared with the control group. The graft maturation score at autopsy significantly correlated with the SNQ (r = − 0.83, p < 0.01). The tunnel diameter of the femoral tunnel at the aperture (r = 0.883, p = 0.03) and mid-portion (r = 0.941, p = 0.02) positively correlated with the SNQ. Conclusions BMSCs and PRP significantly enhanced graft maturation, which indicates that orthobiologics can accelerate the biologic events in tendon allograft incorporation. Femoral tunnel expansion significantly correlated with inferior maturation of the intra-articular graft. The clinical relevance of this study is that BMSCs and PRP enhance allograft healing in a translational model, and biological modulation of graft healing can be evaluated non-invasively using MRI.

Download Full-text

The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2017.096 ◽

2017 ◽

Vol 5 (5) ◽

pp. 624-629 ◽

Cited By ~ 4

Author(s):

Alan Goce Andonovski ◽

Sonja Topuzovska ◽

Milan Samardziski ◽

Zoran Bozinovski ◽

Biljana Andonovska ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Clinical Results ◽

Control Group ◽

Single Bundle ◽

Knee Stability ◽

The Mean ◽

Anterior Cruciate ◽

Proprioceptive Function

BACKGROUND: Anterior Cruciate Ligament (ACL) remnants have important biomechanical, vascular and proprioceptive function.AIM: To determine the influence of the ACL residual remnants after partial and complete ACL ruptures on postoperative clinical results in patients with remnant preserving ACL reconstruction.PATIENTS AND METHODS: The study included 66 patients divided into two groups. In patients from the investigation group remnant preserving ACL reconstruction was performed, in patients from the control group single bundle ACL reconstruction was performed. The results were assessed by Rolimeter measurements, Lysholm and Tegner scores and proprioception evaluation.RESULTS: The mean side-to-side difference of anterior tibia displacement (mm) was improved from 4.4 ± 1.06 to 0.4 ± 0.7 in the investigation group, and from 4.6 ± 0.68 to 1.9 ± 0.64 in the control group (p < 0.001). Difference in the angles in which the knee was placed by the device and the patient has improved from 1.5 ± 0.96° to 0.5 ± 0.53° in the investigation group and from 1.8 ± 0.78° to 1.3 ± 0.97° in the control group (p < 0.05). Tegner and Lysholm scores showed no difference between the groups.CONCLUSION: Preservation of the ACL residual bundle provides a better knee stability and proprioceptive function.

Download Full-text

Vancomycin Presoaking of the Graft Appears to Prevent Infection After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

HSS Journal ® ◽

10.1177/15563316211011682 ◽

2021 ◽

pp. 155633162110116

Author(s):

Francisco Figueroa ◽

David Figueroa ◽

Rafael Calvo ◽

Alex Vaisman ◽

Marilaura Nuñez ◽

...

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meta Analysis ◽

Case Series ◽

Control Group ◽

Infection Rates ◽

Reconstruction Methods ◽

Anterior Cruciate

Background: Vancomycin presoaking of the graft has been shown to decrease infection rates in some case series of anterior cruciate ligament (ACL) reconstruction. Purpose: We sought to substantiate the efficacy of vancomycin presoaked grafts for the prevention of infection after ACL reconstruction. Methods: We performed a systematic review of Medline and OVID to assess the incidence of postoperative infection in studies comparing patients undergoing ACL reconstruction with the use of vancomycin presoaked ACL grafts and a control group of patients undergoing ACL reconstruction without the use of presoaked grafts. The efficacy of vancomycin presoaking was calculated using the Agresti-Coull confidence interval. Relative risk (RR) was calculated for every study and the total sample. Results: The 11 studies that met inclusion criteria comprised 24,298 patients. In patients with vancomycin presoaking of the graft, 1 infection was reported in 8764 cases (0.01% rate). In the studies with control groups that did not have vancomycin presoaked grafts, there were 125 infections in 15,534 ACL reconstructions (0.8% rate). The efficacy of vancomycin presoaking in preventing infection after ACL reconstruction was 99.9% (0.999%–1.000% CI). The overall RR obtained was 0.07 (0.03–0.16 CI). All included studies were retrospective cohort studies (level III). Conclusions: Vancomycin presoaking of the graft has been shown to decrease infection rates after ACL reconstruction in studies of low evidence level. This suggests the need for prospective randomized controlled trials addressing this issue so that recommendations on the routine use of vancomycin presoaking of ACL grafts can be made with confidence.

Download Full-text

Career Length and Injury Incidence After Anterior Cruciate Ligament Reconstruction in Major League Soccer Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117750825 ◽

2018 ◽

Vol 6 (1) ◽

pp. 232596711775082 ◽

Cited By ~ 6

Author(s):

Amelia Joanna Hanford Arundale ◽

Holly Jacinda Silvers-Granelli ◽

Lynn Snyder-Mackler

Keyword(s):

Anterior Cruciate Ligament ◽

Lower Extremity ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Control Group ◽

Lower Extremity Injuries ◽

Career Length ◽

Major League Soccer ◽

Anterior Cruciate ◽

Extremity Injuries

Background: Little is known about career length after anterior cruciate ligament (ACL) reconstruction in Major League Soccer (MLS), the top men’s professional soccer league in the United States. Further, it is unspecified whether athletes returning to soccer after ACL reconstruction are at a higher risk for injuries, beyond new knee injuries. Purpose: To examine career length and the incidence of lower extremity injuries in MLS athletes after ACL reconstruction in comparison with age-matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Injuries and athletic exposures (AEs; games and training sessions) were recorded in the HealtheAthlete database, the injury surveillance system of MLS. All athletes who had undergone ACL reconstruction and returned to MLS were identified and age-matched with controls. Multivariate analyses of variance were used to compare career length and percentage of regular/postseason games that athletes started, substituted, or did not play. Generalized linear model regressions were used to examine the injury risk. Results: Athletes in the ACL group had shorter careers (1.3 ± 1.3 years) than those in the control group (2.5 ± 1.3 years) ( P < .01), but while they were playing, athletes in the ACL group participated in a similar number of AEs as those in the control group (169.9 ± 129.0 vs 171.6 ± 124.9 AEs, respectively; P = .95). Athletes in the ACL group started fewer regular/postseason games (36.7% ± 34.3% vs 60.1% ± 33.8%, respectively; P < .01) and did not play in more regular/postseason games (47.4% ± 35.5% vs 31.0% ± 34.4%, respectively; P = .03) compared with those in the control group. The ACL group was not at a significantly greater risk for lower extremity injuries compared with the control group (relative risk, 0.87; 95% CI, 0.55-1.37). Conclusion: Although MLS athletes after ACL reconstruction are not at a greater risk for lower extremity injuries, this study suggests that they are not utilized in regular/postseason games as frequently and that their careers in MLS are shorter than age-matched controls. Further research is necessary to elucidate reasons for these athletes’ shortened MLS careers. This study supports the view of return to sport not as a single time point but as a continuum from return to participation to return to play and return to performance.

Download Full-text

Reducing Intra-Articular Haemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00136 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0013

Author(s):

Fatih Karaaslan ◽

Sinan Karaoğlu ◽

Musa Uğur Mermerkaya

Keyword(s):

Anterior Cruciate Ligament ◽

Blood Loss ◽

Anterior Cruciate Ligament Reconstruction ◽

Acl Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Control Group ◽

Double Blind Study ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

Objectives: A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. Haemarthrosis and pain adversely affects the functional outcome of ACL reconstruction. The purpose of the study was to evaluate the effect of tranexamic acid (TXA) administration to minimize pain and stiffness of knee joint by reducing haemarthrosis. Methods: The study enrolled 123 patients who underwent arthroscopic anterior cruciate ligament reconstruction in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group (71 patients) received both intravenous and intra-articular TXA. The control group (52 patients) did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 minutes before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 minutes before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 hours. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively. Results: The mean (± SD) postoperative volume of blood loss from the drain in the TXA and control groups was 100.6 ± 72mL and 164.3 ± 75mL ml, respectively. The difference between the two groups was significant (p < 0.005). Conclusion: This prospective randomized study showed that during arthroscopic anterior cruciate ligament reconstruction, TXA reduced blood loss and helped to reduce haemarthrosis amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for puncturing associated with arthroscopic anterior cruciate ligament reconstruction without enhancing the risk of deepssssssahrombosis.

Download Full-text