ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2021
Toxicity of tranexamic acid (TXA) to intra-articular tissue in orthopaedic surgery: a scoping review.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
21 citing papers in PubMed, 37 citations in OpenAlex.
- Efficacy of Different Doses of Intra-Articular Tranexamic Acid for Reducing Blood Loss and Lower Limb Swelling After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial.Orthopaedic surgery · 2025Trial
- Tranexamic acid in shoulder surgery: a narrative review.JSES reviews, reports, and techniques · 2026Review
- The Efficacy of Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis.Advances in orthopedics · 2026Review
- Intraarticular Tranexamic Acid in Arthroscopic Knee Procedures: Has There Been Any Progress in the Last 5 Years (2021-2025)?The archives of bone and joint surgery · 2026Article
- Evidence on oral tranexamic acid versus intravenous tranexamic acid for perioperative blood management in total knee arthroplasty: a systematic review and meta-analysis.EFORT open reviews · 2025Article
- Tranexamic acid use in rotator cuff repair: A systematic review of perioperative outcomes.Journal of orthopaedics · 2025Review
- Consensus document on the management of wound closure in orthopaedic surgery.EFORT open reviews · 2025Review
- Tranexamic acid in arthroscopic surgery: efficacy, safety, and clinical considerations.Frontiers in surgery · 2025Review
- Does Combined Treatment with Tranexamic Acid and Vancomycin Affect Human Chondrocytes In Vitro?Pharmaceuticals (Basel, Switzerland) · 2024Article
- Can local infiltration analgesia supplemented with tranexamic acid reduce blood loss during total knee arthroplasty?BMC musculoskeletal disorders · 2024Article
- Tranexamic Acid Attenuates the Progression of Posttraumatic Osteoarthritis in Mice.The American journal of sports medicine · 2024Article
- Tranexamic acid administered intraarticularly to the knee is safer for the articular cartilage and anterior cruciate ligament compared to intravenous administration: Histological analysis of an experimental rat model.Naunyn-Schmiedeberg's archives of pharmacology · 2024Article
- Is tranexamic acid safe for the hip joint?Naunyn-Schmiedeberg's archives of pharmacology · 2024Article
- Hemostatic effect of oxidized regenerated cellulose vs. topical tranexamic acid in total knee arthroplasty-a prospective randomized controlled trial.Frontiers in surgery · 2024Article
- Validation of the antibacterial effect of topically applied tranexamic acid usingFrontiers in microbiology · 2024Article
- Topical administration of tranexamic acid reduces postoperative blood loss and inflammatory response in knee arthroscopic arthrolysis: a retrospective comparative study.BMC musculoskeletal disorders · 2023Article
- Topical use of tranexamic acid: Are there concerns for cytotoxicity?World journal of orthopedics · 2022Review
- Cytotoxicity of tranexamic acid to tendon and bone in vitro: Is there a safe dosage?Journal of orthopaedic surgery and research · 2022Article
- Tranexamic Acid in Combination With Vancomycin or Gentamicin Has a Synergistic Effect Against Staphylococci.Frontiers in microbiology · 2022Article
- Population Pharmacokinetics of Intra-articular and Intravenous Administration of Tranexamic Acid in Patients Undergoing Total Knee Replacement.Clinical pharmacokinetics · 2022Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIntra-articular administration of tranexamic acid (TXA) in orthopaedic arthroplasty and arthroscopic procedures has become increasingly common over the past decade. However, several recent reports have shown that TXA has the potential to be cytotoxic to cartilage, tendon and synovium. Our aim was to review the literature for evidence of toxic effects from TXA exposure to intra-articular tissue.
methodsA scoping review methodology was used to search for studies assessing the toxic effects of TXA exposure to intra-articular tissues. MEDLINE, EMBASE, SCOPUS and The Cochrane Library were searched. Relevant information was extracted and synthesis of the retrieved data followed a basic content analytical approach.
resultsA total of 15 laboratory studies were retrieved. No clinical studies reporting a toxic effect of TXA on intra-articular tissue were identified in our search. Studies were analysed according to species of origin, tissue of origin and study setting (in vitro, ex vivo, or in vivo). There was increasing cytotoxicity to chondrocytes, tenocytes, synoviocytes and periosteum-derived cells with TXA concentrations beyond 20 mg/ml. Monolayer cell cultures appear more susceptible to TXA exposure, than three-dimensional and explant culture models. In vivo studies have not demonstrated a major toxic effect.
conclusionsCurrent evidence suggests a dose-dependent toxic effect on cartilage, tendon, and synovial tissue. Concentrations of 20 mg/ml or less are expected to be safe. There is a significant body of evidence to suggest the need for caution with intraarticular administration of TXA. There is a need for further human clinical trials in order to clarify the long-term safety of TXA topical application.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.