The Efficacy of Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis.

Abstract

Introduction: Arthroscopic reconstruction of the anterior cruciate ligament (ACL) is a well-established surgical intervention following ligament compromise. Administration of tranexamic acid (TXA), an antifibrinolytic agent, has been trialed to improve a variety of surgical outcomes following ACL reconstruction. The objective of this study is to further analyze the effect of TXA on postoperative drain output, functional scores, and overall knee functionality following ACL reconstruction.

Methods: Literature retrieval was accomplished using PubMed and Google Scholar up until May 2025. Studies were included if ACL reconstruction outcomes were compared between TXA and control groups and if the relevant outcomes were reported. Review Manager Web was used for statistical analysis, and p values ≤ 0.05 were considered statistically significant.

Results: 14 studies were ultimately included in this meta-analysis, totaling 1328 patients: 689 in the TXA group and 639 in the control group. Regarding VAS scores, significant differences were seen at 1 day (p = 0.02), 1 week (p < 0.001), 2 weeks (p = 0.02), and 4 weeks postoperation (p = 0.01) in favor of the TXA group. Regarding range of motion (ROM), a significant difference was found at 2 weeks postoperation (p = 0.005) in favor of TXA. Regarding the drain output measured 1 day postoperatively, the TXA group had a significantly lower drain output than the control group (p < 0.001). No significant differences were found in hemoglobin levels measured 1 day postoperation, Lysholm score at 1 and 3 months postoperation, VAS at 6 weeks postoperation, and ROM at 1 day and 4 weeks postoperation.

Conclusion: The TXA group demonstrated significantly better drainage output, pain scores, and ROM in the early postoperative period. The use of TXA in ACL reconstruction appears to yield promising results, leading to a more prompt and efficient rehabilitation process and an overall reduction in pain for patients.