Tranexamic acid (TXA) is an anti-fibrinolytic medication commonly used to reduce peri-operative bleeding. Increasingly, topical administration as an intra-articular injection or peri-operative wash is being administered at concentrations between 10–100mg/ml. This study investigated effects of TXA on human periarticular tissues and primary cell cultures using clinically relevant concentrations. Tendon, synovium and cartilage obtained from routine orthopaedic surgeries were used ex vivo or cultured for in vitro studies using various concentrations of TXA. They were stained with 5-chloromethylfluorescein diacetate and propidium iodide and imaged using confocal microscopy to identify the proportion of live and dead cells. The in vitro effect of TXA on primary cultured tenocytes, synovial like fibroblast (FLS) cells and chondrocytes was investigated using cell viability assays (MTT), fluorescent microscopy and multi-protein apoptotic arrays for cell death. There was significant (p<0.01) increase in cell death in all tissue treated with 100mg/ml TXA, ex vivo. MTT assays revealed significant (p<0.05) decrease in cell viability following treatment with 50 or 100mg/ml of TXA within 4 hours of all cell types cultured in vitro. Additionally, there was significant (p<0.05) increase in cell apoptosis detected by fluorescent microscopy within 1 hour of exposure to TXA. Furthermore, multi-protein apoptotic arrays detected increased apoptotic proteins within 1 hour of TXA treatment in tenocytes and FLS cells. Our study provides evidence of TXA cytotoxicity to human peri-articular tissues ex vivo and in vitro at concentrations and durations of treatment routinely used in clinical environments. Clinicians should therefore show caution when considering use of topical TXA administration.
The aim of this study was to determine if patient reported outcome scores for arthroscopic meniscectomy are adversely affected by the degree of knee osteoarthritis or patient body mass index (BMI). All patients who underwent arthroscopic meniscectomy within the NHS in Scotland between 6th February and 29th April 2012 were audited as part of the Scottish Government Musculoskeletal Knee Arthroscopy Audit and were eligible for inclusion within this study. A total of 270 patients returned both their pre-operative and post-operative EuroQol 5Q5D5L descriptive questionnaire and Knee injury and Osteoarthritis Outcomes Scores. Patients were stratified according to BMI, degree of osteoarthritis, history of injury, and duration of knee symptoms. Pre-operative to post-operative EuroQol index scores [0.642±0.253 to 0.735±0.277, median±SD] and Knee injury and Osteoarthrtis Outcome Scores [44.63±18.78 to 62.28±24.94, median±SD] improved across all patients (p<0.0001). This was irrespective of degree of BMI, history of injury, or duration of symptoms. There was no such improvement in patients with moderate to severe osteoarthritis. Those patients with a BMI >35 kg/m2 had lower post-operative scores than the pre-operative scores of those of BMI <30 kg/m2. Arthroscopic meniscectomy is beneficial regardless of patient BMI, duration of symptoms, history of injury, or in the presence of mild arthritis.
