ABSTRACT
Introduction: Tranexamic acid (TXA) use has become common in orthopedic surgeries. Despite the growing number of publications related to its use, no recent systematic reviews have been published examining TXA use in foot and ankle surgery. The purpose of this review article is to provide a summary of the current available literature regarding TXA use in foot and ankle surgery and to further the understanding of its safety and efficacy. Methods: This systematic review utilized PubMed, Ovid, CINAHL, Clinical Key, Medline, and Embase, and the search was conducted through December 22, 2022. Key words used in the search included: "tranexamic acid," "TXA," "foot," "ankle," "calcaneal," and "surgery." The outcomes within the studies analyzed included measures of perioperative blood loss (intra-operative blood loss, 24-hour post-operative blood loss, blood loss from hour 24 to hour 48, post-operative hemoglobin (Hgb), and post-operative hematocrit [Hct]), as well as wound complications and vascular events. Meta-regression was included to assess the impact of age on between-study variation. Results: Ten studies met preliminary inclusion criteria. Upon further inspection, eight met full inclusion criteria for the meta-analysis. Despite a growing amount of literature on the topic, there is still a paucity of literature published on TXA use in foot and ankle surgery. Current literature suggests that foot and ankle surgery patients treated with TXA may have reduced 24-hour post-operative blood loss (MD=-183.41 mL, 95% CI=-247.49 to -119.34 mL, p<0.001), increased post-operative hemoglobin (MD=0.71 g/dL, 95% CI=0.11 to 1.31 g/dL, p=0.020) and hematocrit (MD=2.66%, 95% CI=0.07 to 5.24%, p=0.040) when compared to similar patients not receiving TXA. The use of TXA in foot and ankle surgery did not lead to increased thromboembolic complications. Meta-regression indicated no clinically relevant association of age to between-study variation. Conclusions: TXA was found to be a safe treatment that did affect wound healing or infection rates while decreasing perioperative blood loss. Further research should be performed to evaluate the long-term effects of TXA administration on patient outcomes after foot and ankle surgery.
ABSTRACT
PURPOSE: To assess the relationships between physical function tests of the operative limb and psychological readiness to return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction (return to sport after injury [ACL-RSI]) by sex. A secondary purpose was to quantify sex-specific differences in physical function test outcomes. METHODS: Patient records were retrospectively identified as cases who performed RTS physical function testing (strength, horizontal hops, vertical jumps, single-leg leg press, and drop landing knee excursion, etc.), and completed a 6-question ACL-RSI survey at the time point they were cleared to RTS. Independent t-tests compared all variables between sex at P ≤ .05. Correlations and regression models were produced per sex to identify factors related to operative limb physical function tests and ACL-RSI scores. RESULTS: With a total of 127 patients (63 men; 64 women), there was no difference in ACL-RSI scores and leg press repetitions between sex (P = .32 and P = .12, respectively). There were sex differences for all other physical performance outcomes (P < .001 for all). To estimate readiness using physical function test scores, the men's regression model identified knee excursion (ß = 0.345; P = .033) as the only contributor to ACL-RSI (R2 = 0.089), whereas there was no relationship between physical performance outcomes and ACL-RSI in women (R2 = 0.00, P = 1.00). CONCLUSIONS: Men and women reported similar ACL-RSI scales, indicating high readiness to return to sport. Likely due to sex-related physiological differences, men performed better at most physical function tests. Further, male ACL-RSI could be predicted using only one physical function outcome and 91% variability of the ACL-RSI coming from other contributors not evaluated, as indicated by R2. No physical function variables predict ACL-RSI in women. The evaluated variables are considered the primary indicators relevant for patients to be permitted to RTS yet cannot adequately predict psychological readiness in these patients. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
