The role of tranexamic acid use in primary anterior cruciate ligament reconstruction; a prospective comparison

Background: The purpose of this study was to evaluate the effects of tranexamic acid (TXA) in anterior cruciate ligament reconstruction (ACLR) with a focus on bleeding, hemarthrosis, postoperative pain, and early rehabilitation outcomes.Objectives: This study was conducted to investigate whether the use of TXA in ACLR can significantly reduce intraoperative and postoperative bleeding while improving pain management and functional recovery in the early postoperative period.Methods: This prospective, non-randomized observational study included 103 patients undergoing ACLR. Fifty-two patients received intravenous TXA (15 mg/kg) 15 minutes before tourniquet inflation, while 51 patients received no medication. Estimated blood loss, drain output, thigh circumference increase, pain on the first postoperative day, additional analgesic requirements, hospital stay length, and functional outcomes at 8 weeks were compared between groups.Results: The TXA group demonstrated significantly lower drain output (p = 0.001), thigh circumference increment (p = 0.001), and estimated blood loss (p = 0.001) compared to the control group. However, no significant differences were observed in postoperative pain (p = 0.807), additional analgesic requirements (p = 0.386), hospital stay length (p = 0.062), or functional outcomes at 8 weeks (p = 0.397). None of the patients required blood transfusion or knee aspiration for hemarthrosis.Conclusions: Although TXA reduces bleeding parameters during ACLR, it does not significantly impact postoperative pain or functional recovery. Its clinical benefit appears limited to reducing bleeding without altering overall postoperative management.