IV Tranexamic Acid is Likely Safer Than Intra-articular TXA Before Arthroscopic Surgery

We rarely share a lab-science study, but this one refines an earlier suggestion we made to achieve the same efficacy with greater safety.

Smart Practice: Refining a post from a week ago, if you’re going to use TXA before arthroscopic surgery, IV may be better than intra-articular to reduce risk of cartilage damage.

What’s the Claim?

To keep things practical, we almost never post about lab-science discoveries, but here’s one: Tranexamic acid (TXA) had toxic effects on chondrocytes. The doses the researchers used were high, but since they were plausibly comparable to some intra-articular applications during arthroscopic surgery (they studied 50 and 100 mg/mL), we considered this safety message relevant enough to share.

How’s It Stack Up?

The impact is probably best summarized in a sentence from CORRelations’ advisor in Arthroscopy & Sports, Brian Gilmer, MD: “TXA appears to be chondrotoxic, as are the local anesthetics we frequently inject and the epinephrine they are often mixed with.”

That about covers it. It doesn’t mean we don’t use those drugs in joints, and some lab data suggest that TXA may be less chondrotoxic than epinephrine, but if there are alternatives — and in this case, there’s a good one — why not make a potentially safer choice?

What’s Our Take?