The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Intraarticular Tranexamic Acid in Arthroscopic Knee Procedures: Has There Been Any Progress in the Last 5 Years (2021-2025)?

Document Type : EDITORIAL

Author
E. Carlos RODRIGUEZ-MERCHAN
Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain
10.22038/abjs.2026.93762.4230
Abstract
Two of the four articles published after September 2020 were systematic reviews. The first systematic review found that concentrations of TXA beyond 20 mg/mL were cytotoxic to chondrocytes, tenocytes, synoviocytes and periosteum-derived cells. The other systematic review suggested that the utilization of TXA in ACLR diminished the need for joint aspiration, articular bleeding, drain output, and knee inflammation in the postoperative period. The other two articles were clinical studies. One of them contemplated IA-TXA as a potentially efficacious and relatively safe option to diminish postoperative bleeding and pain in ACLR individuals. The other clinical study found that IA-TXA was efficacious in diminishing postoperative bleeding and early postoperative pain in individuals who underwent arthroscopic synovectomy of PVNS. Given the scarcity of well-designed studies on the long-term impact of IA-TXA on chondrocytes, we cannot know whether IA-TXA is harmful in the long-term, although it certainly appears to be beneficial in the short-term following some arthroscopic knee procedures (diminish postoperative bleeding and pain in ACLR and PVNS individuals). It is clear that very little progress has been made in the last five years and that well-designed, long-term studies will be needed to determine whether IA-TXA is harmful to chondrocytes in arthroscopic knee surgery.
Keywords
knee
arthroscopic procedures
tranexamic acid
intraarticular
efficacy
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 8
August 2026
Pages 488-490

  • Receive Date 22 December 2025
  • Revise Date 13 May 2026
  • Accept Date 29 April 2026