Intra‑articular tranexamic acid improves 1‑ and 3‑month functional recovery but does not reduce early post‑operative pain after arthroscopic ACL reconstruction: A triple‑blind randomised trial.

Purpose: Our aim is to investigate whether an intra-articular injection of tranexamic acid (TXA), administered alongside a standard multimodal analgesic cocktail, improves postoperative pain control and functional recovery. Methods: This was a randomised, triple-blind, placebo-controlled clinical trial conducted from April 2022 to October 2023 at a tertiary care center. One hundred patients with isolated, unilateral, chronic ACL tears were randomised 1:1 to receive either an intra-articular injection containing TXA (1 g), morphine sulphate, ketorolac, lidocaine and normal saline (intervention group) or an identical injection without TXA (control group). All surgeries were performed using hamstring autografts and standardised surgical and postoperative protocols. All patients received 15 mg/kg intravenous TXA in addition to intra-articular TXA. The primary outcomes were pain scores (Visual Analogue Scale, VAS) at predefined time points up to 3 months. The secondary outcomes were Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm scores, range of motion, swelling and morphine consumption. Results: Postoperative pain scores did not differ significantly between groups at any time point (p > 0.05). Both groups demonstrated significant within-group improvements over time in KOOS subscores (p < 0.001) and Lysholm scores (p < 0.001). Postoperative morphine consumption was similar in both groups (p > 0.05). The TXA group had better Lysholm scores at 1 month (85.8 ± 9.1 vs. 79.6 ± 13.9; p < 0.01). The TXA group had significantly better KOOS subscores and Lysholm scores at 3 months with moderate effect size (p < 0.01). No serious complications were observed in either group. Conclusion: Intra-articular TXA did not significantly reduce early postoperative pain or opioid use when added to a multimodal analgesic regimen and intravenous TXA in arthroscopic ACL reconstruction. However, it was associated with modest improvements in functional recovery at 1 and 3 months postoperatively, as measured by KOOS and Lysholm scores. Level of Evidence: Level I.