Investigation of the Effects of Intra-articular Tranexamic Acid on Intact Cartilage Tissue and Cartilage Formation in Osteochondral Defects of the Rabbit Knee: An Experimental Study.

Fevzi̇ Bi̇Ri̇Si̇K,Evşen Apaydın,Serkan Bayram,Mehmet Çakmak,Ali Erşen

doi:10.7759/cureus.14873

Abstract

BackgroundIn this study, the effects of tranexamic acid (TXA) and saline on intact cartilage and the recovery of experimental osteochondral lesions following microfracture in a rabbit model were compared.MethodsTwenty adult rabbits were divided into four groups (1A, 1B, 2A, and 2B) based on with or without TXA use and microfracture. In addition, these groups were categorized into two different subgroups based on the use of TXA in Groups 1 and 2 (Groups A and B). Full-thickness cartilage defects were created on the weight-bearing surface of the medial femoral condyles unilaterally in Group 2 for the effect of TXA or saline on healthy cartilage tissue while a repetitive injection was applied in Group 1 for the effect of TXA or saline on intact cartilage. A single dose of 10 mg/kg TXA was injected into the knee joints of Group A and 10 mg/kg 0.9% saline solution injected in Group B for three consecutive days. All animals were sacrificed for the extraction of the medial condyles for histologic evaluation eight weeks after surgery. The International Cartilage Repair Society (ICRS) II scoring system was used for histologic evaluation.ResultsNo complications or adverse effects related to surgery were observed in all rabbits. All ICRS II parameters were similar in the TXA and saline solution groups in the intact cartilage group except for chondrocyte clustering, formation of a tidemark, subchondral bone abnormalities, and mid/deep zone assessment. Moreover, these parameters were higher in the saline solution group in the cartilage group, but no significant difference was observed in the TXA group in the intact cartilage group. All ICRS II parameters were higher in the saline solution group than in the TXA group in the microfracture group, but no significant difference was observed in the TXA group in the microfracture group except for inflammation, which was similar in the TXA and saline solution groups in the microfracture group.ConclusionWe found that intra-articular TXA administration did not have a negative impact on healthy cartilage tissue and cartilage transformation and proliferation as compared to the saline infusion.

Highlights

Tranexamic acid (TXA) is an antifibrinolytic agent that prevents plasmin formation, inhibiting the breakdown of fibrin clots [1,2]
All International Cartilage Repair Society (ICRS) II parameters were similar in the tranexamic acid (TXA) and saline solution groups in the intact cartilage group except for chondrocyte clustering, formation of a tidemark, subchondral bone abnormalities, and mid/deep zone assessment
All ICRS II parameters were higher in the saline solution group than in the TXA group in the microfracture group, but no significant difference was observed in the TXA group in the microfracture group except for inflammation, which was similar in the TXA and saline solution groups in the microfracture group

Summary

Introduction

Tranexamic acid (TXA) is an antifibrinolytic agent that prevents plasmin formation, inhibiting the breakdown of fibrin clots [1,2]. Previous studies have reported the systemic and topical use of TXA for reducing blood loss and the need for blood transfusions [3,4]. TXA can be administered intravenously, intra-articularly, or orally in the setting of surgery. Intravenous TXA is widely used, it may be associated with postoperative seizures and increased thromboembolic events [7]. Intra-articular application is preferred for reducing blood loss and the need for blood transfusions, which has been increasing over the past several years [8]. The effects of tranexamic acid (TXA) and saline on intact cartilage and the recovery of experimental osteochondral lesions following microfracture in a rabbit model were compared

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Discussion

Conclusion