Efficacy of Intra-Articular Tranexamic Acid in Reducing Early Postoperative Swelling and Pain Following Arthroscopic ACL Reconstruction: A Randomized Comparative Study

Postoperative pain, swelling, and hemarthrosis are common early complications following arthroscopic anterior cruciate ligament (ACL) reconstruction. These complications can impede early rehabilitation and negatively affect patient satisfaction. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing perioperative blood loss in various orthopaedic surgeries. However, evidence regarding its intra-articular use in ACL reconstruction is still evolving.The purpose of this study was to evaluate the efficacy and safety of intra-articular TXA in reducing early postoperative swelling, pain, and wound soakage following arthroscopic ACL reconstruction.This randomized controlled trial included 100 patients undergoing primary arthroscopic ACL reconstruction. Participants were randomized into two groups (<i>n</i> = 50 each). Group 1 received 1 g (10 mL) of intra-articular TXA at the end of surgery, while Group 2 received 10 mL of normal saline. Postoperative outcomes assessed included wound soakage, swelling (graded 0-3), and pain using the Visual Analog Scale (VAS) on postoperative day 3. Functional and pain outcomes were evaluated at 6 months using the Lysholm Knee Score and VAS.The TXA group demonstrated significantly lower swelling scores (mean 0.9 vs. 1.8, <i>p</i> < 0.001), reduced VAS pain scores on day 3 (mean 3.2 vs. 4.8, <i>p</i> < 0.001), and no cases of wound soakage compared to eight cases in the control group (<i>p</i> < 0.05). At 6 months, both groups had comparable Lysholm scores and VAS pain scores, indicating similar short-term outcomes. No adverse events were reported in either group.Intra-articular TXA significantly improves early postoperative outcomes in arthroscopic ACL reconstruction by reducing pain, swelling, and wound soakage. TXA is safe and may be considered a part of enhanced recovery protocols in ACL surgery.