Intraoperative tranexamic acid reduces postoperative haemarthrosis and improves early functional outcomes in double-bundle anterior cruciate ligament reconstruction

Double-bundle anterior cruciate ligament reconstruction (ACLR) has biomechanical advantages but is associated with increased intraoperative bleeding. The role of tranexamic acid (TXA) in reducing postoperative joint haemarthrosis and improving the short-term outcomes of double-bundle ACLR has not yet been thoroughly investigated. This study aimed to assess the effects of intraoperative TXA on postoperative joint haemarthrosis and short-term functional outcomes in patients who underwent double-bundle ACLR. This retrospective cohort study included 80 male patients who underwent double-bundle ACLR between January 2019 and December 2022. The patients were divided into two groups: those who received TXA and those that did not. The TXA group received 50 mL of TXA (10 mg/mL) intravenously approximately 10 min before tourniquet release, followed by an intra-articular injection of 50 mL TXA (10 mg/mL) immediately after wound closure, prior to tourniquet release, whereas the control group did not receive TXA. Primary outcomes included postoperative haemarthrosis volume, assessed using Coupens and Yate (CY) values; and short-term functional recovery, evaluated using range of motion (ROM), quadriceps strength, and visual analogue scale (VAS) pain scores on day 1, day 15, week 6, and week 12 postoperatively. Intraoperative administration of TXA in patients undergoing double-bundle ACLR reduced postoperative haemarthrosis, as measured by a lower CY value on postoperative day 1 (P = 0.004) and day 15 (P < 0.001). Compared to patients in the control group, patients in the TXA group reported lower VAS pain scores on day 1 (P < 0.001), day 15 (P < 0.001), and week 6 (P = 0.028), together with improved quadriceps strength (P = 0.043, day 1; P = 0.009, day 15) and ROM (P < 0.001, 12 weeks postoperatively) during the early postoperative period. The use of TXA during double-bundle ACLR may reduce postoperative joint haemarthrosis and enhance short-term functional outcomes.