Study of the effect of using antihemorrhagic drugs and the use of intraarticular drain after arthroscopic anterior cruciate ligament reconstruction on the outcome of the procedure

Background
Reconstruction of the anterior cruciate ligament (ACL) is crucial for maintenance of the stability of the knee. ACL reconstruction is a bloody operation owing to the formation of transosseous tunnels. Blood might obscure the view during surgery and may collect postoperatively to impair the range of movement and slow down the rate of rehabilitation. The use of intraarticular (IA) drains might be helpful in that issue; however, the risk of introduction of infection to the joint might be increased.
Hypothesis
The purpose of this study was to determine whether the use of IA drains are necessary for improving outcomes after arthroscopic ACL reconstruction and also whether the use of preoperative antihemorrhagic drugs might preclude the use of IA drains.
Patients and methods
A total of 60 adult patients (60 knees) with documented ACL injury were eligible for arthroscopically assisted ACL reconstruction. The patients were randomly divided into two groups, each consisting of 30 patients. Both groups had anatomical single-bundle ACL reconstruction using the transaccessory femoral portal approach. The ACL graft substitute was hamstring tendon autograft in 25 cases and quadriceps tendon autograft in five cases. In the first group, an IA drain was fixed at the end of surgery, without preoperative antihemorrhagic drugs. The second group was given antihemorrhagic drugs IV (tranexamic acid 500 mg/5 ml, trade name Kapron) 1 h before surgery, and no drain was applied at the end of the operation. The patients were examined for the degree of knee swelling, pain as assessed by the visual analog scale, amount of blood collected, and range of movement. These parameters were reassessed after 2 weeks and at the end of the follow-up at 3 months postoperatively.
Results
Group 1 with the drain tended to have less pain and swelling in the immediate postoperative period, more wasting of the quadriceps at the end of follow-up, and comparatively lower mean range of motion (ROM) at the end of follow-up. On the contrary, group 2 without drain tended to have more swelling in the immediate postoperative period, which decreased dramatically over time to be significantly lower than that in patients in group 1 at a comparable stage of follow-up. Only four patients developed significant hemarthrosis that needed aspiration with a wide-bore needle in group 2. The final mean ROM is significantly better in this group. The rate of infection tended to be lower in group 2 without a drain, but with no statistically significant results.
Conclusion
The use of IA drain after arthroscopic ACL reconstruction decreases pain and swelling in the immediate postoperative period. However, patients among group 2 despite having more pain and swelling in the immediate postoperative period recovered more rapidly and more effectively, having a comparatively better ROM and less wasting of the quadriceps at the end of follow-up. The rate of infection tended to be lower in group 2 without a drain, but with no statistically significant results. The preoperative use of parenteral antihemorrhagic medication decreases the intraoperative bleeding and improves visualization during arthroscopic surgery; moreover, it may be beneficial in decreasing the postoperative hemarthrosis.