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. 2025 Aug 11:15563316251357603.
doi: 10.1177/15563316251357603. Online ahead of print.

Evaluation of the Effect of Tranexamic Acid on Meniscus Healing and Articular Cartilage in a Rabbit Model

Jonathan Sgaglione  1   2 , Janice Havasy  1   2 , Ronak Patel  1 , Ryan Healy  1 , Vincent Yao  1 , Yulei Liu  1 , Ian Hutchinson  1 , Michael Sama  1 , Alexander Piacentini  1 , Xianghua Deng  1 , Scott Rodeo  1
Affiliations

Evaluation of the Effect of Tranexamic Acid on Meniscus Healing and Articular Cartilage in a Rabbit Model

Jonathan Sgaglione et al. HSS J. .

Abstract

Background: The formation of a stable fibrin clot plays an important role in early tissue repair. Tranexamic acid (TXA), a potent fibrinolysis inhibitor, prevents fibrin clot dissolution.

Purpose: We sought to test the effect of intra-articular TXA administration on meniscus healing and articular cartilage status in a rabbit model.

Methods: Thirty-two rabbits underwent bilateral knee surgery with creation of a 1.5-mm circular defect in the anterior horn of the lateral meniscus and a 3-mm longitudinal tear with repair in the anterior horn of the medial meniscus. Twelve rabbits were used for an initial TXA dose determination study. Twenty rabbits were then injected with 50 mg/mL of TXA in the left knee while the right knee served as a control. Animals were sacrificed at 2-, 4-, and 8-week timepoints. Eight rabbits underwent biomechanical analysis. Semiquantitative histological analysis compared meniscal healing and articular cartilage between TXA-treated and control knees.

Results: Both circular defects of the lateral meniscus and longitudinal tear injuries of the medial meniscus showed no difference in healing across all timepoints. At 2 weeks post-surgery, TXA-treated knees exhibited reduced tibial articular cartilage structure compared to controls. By week 8, control knees had higher proteoglycan content in all femoral articular cartilage zones compared to TXA-treated knees. Biomechanical analysis was inconclusive.

Conclusion: This rabbit study found that TXA administration did not enhance healing following meniscus repair. Moreover, intra-articular TXA appeared to have exerted an adverse effect on articular cartilage, possibly due to the detrimental effects of persistent blood in a joint. Further studies will be critically important to determine the effect of TXA administration at various time points after surgical repair.

Keywords: articular cartilage; fibrin clot; meniscus; rabbit; tranexamic acid (TXA).

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Scott Rodeo, MD, reports relationships with Arthritis Foundation, OREF, Ortho RTI, NIH, Angiocrine Biosciences, Novartis, Advance Medical, Jannu Therapeutics, and Overture Medical. The other authors declare no potential conflicts of interest.

Figures

Tissue samples from left (a) medial and (b) lateral rabbit menisci treated with 50 mg/mL of TXA at 7 days.
Fig. 1.
Tissue harvest; 7-day samples of left (a) medial and (b) lateral rabbit menisci treated with 50 mg/mL of TXA. TXA tranexamic acid.
Here are the 16-word descriptions generated using the context data provided, "In two, four, and eight-week intervals, observe tibia specimens stained with hematoxylin, eosin, and Safranin O under magnification, noting the difference between control and TXA-treated limbs.
Fig. 2.
Representative images of 2-, 4-, and 8-week timepoint tibia specimens stained with hematoxylin and eosin (20× magnification) and Safranin O (10× magnification). Panels (a, c) represent control tibia, and panels (b, d) represent tibia treated with 50 mg/mL of TXA. TXA tranexamic acid.
Describe a collection of 2-, 4-, and 8-week femur specimen images, including control and tranexamic acid-treated femurs, stained with hematoxylin, eosin, and Safranin O at magnifications of 20x and 10x
Fig. 3.
Representative images of 2-, 4-, and 8-week timepoint femur specimens stained with hematoxylin and eosin (20× magnification) and Safranin O (10× magnification). Panels (a, c) represent control femur and panels (b, d) represent femur treated with 50 mg/mL of tranexamic acid.
Original: the images are of a human lateral meniscusRephrased: a series of images depict human meniscus tissues under a microscope at 800 microns
Figure 4.
(a) TXA-treated medial meniscal tear (score = 2); (b) control medial meniscal tear (score = 1). (c) Hematoxylin and eosin staining and (d) Safranin O/Fast Green staining of a TXA-treated lateral meniscus defect (score = 13/15). TXA tranexamic acid.
See this image and copyright information in PMC

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References

    1. Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion. 2008;48(3):519–525. - PubMed
    1. Ambra LF, de Girolamo L, Niu W, Phan A, Spector M, Gomoll AH. No effect of topical application of tranexamic acid on articular cartilage. Knee Surg Sports Traumatol Arthrosc. 2019;27(3):931–995. - PubMed
    1. Arnoczky SP, Warren RF, Spivak JM. Meniscal repair using an exogenous fibrin clot. An experimental study in dogs. J Bone Joint Surg Am. 1988;70(8):1209–1217. - PubMed
    1. Blanco FJ, Guitian R, Vázquez-Martul E, de Toro FJ, Galdo F. Osteoarthritis chondrocytes die by apoptosis: a possible pathway for osteoarthritis pathology. Arthritis Rheum. 1998;41(2):284–289. - PubMed
    1. Bolam SM, O’Regan-Brown A, Paul Monk A, Musson DS, Cornish J, Munro JT. Toxicity of tranexamic acid (TXA) to intra-articular tissue in orthopaedic surgery: a scoping review. Knee Surg Sports Traumatol Arthrosc. 2021;29(6):1862–1871. - PubMed

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