Purpose

Intra-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.

Methods

A 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.

Results

A 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.

Conclusions

Current 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.

中文翻译：

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骨外科手术中氨甲环酸（TXA）对关节内组织的毒性：一项研究范围。

目的

在过去的十年中，在骨科关节置换术和关节镜手术中关节内施用氨甲环酸（TXA）变得越来越普遍。但是，最近的一些报道表明，TXA对软骨，肌腱和滑膜具有细胞毒性。我们的目的是回顾文献，以了解TXA暴露于关节内组织的毒性作用。

方法

范围审查方法用于搜索评估TXA暴露于关节内组织的毒性作用的研究。搜索MEDLINE，EMBASE，SCOPUS和Cochrane库。提取相关信息，并遵循基本内容分析方法对检索到的数据进行综合。

结果

总共检索了15个实验室研究。在我们的搜索中，未发现报告TXA对关节内组织有毒性作用的临床研究。根据来源物种，来源组织和研究背景（体外，离体或体内）分析研究。TXA浓度超过20 mg / ml时，对软骨细胞，肌腱细胞，滑膜细胞和骨膜来源的细胞的细胞毒性增加。与三维和外植体培养模型相比，单层细胞培养物似乎更容易受到TXA暴露。体内研究尚未证明主要的毒性作用。

结论

当前证据表明对软骨，肌腱和滑膜组织具有剂量依赖性的毒性作用。浓度在20 mg / ml或以下是安全的。有大量证据表明在关节内施用TXA时需要谨慎。为了阐明TXA局部应用的长期安全性，需要进行进一步的人类临床试验。