PURPOSE OF THE STUDY Anterior cruciate ligament reconstruction is one of the most common reconstruction surgeries. The unintended consequences of the surgery are hemarthrosis, blood loss, knee swelling and postoperative pain. The purpose of the study was to evaluate the effect of a single dose of intravenous tranexamic acid (TXA) on the postoperative parameters and functional status of the knee joint 3 months after surgery. MATERIAL AND METHODS It is a prospective randomised clinical study. An intravenous injection of TXA equivalent to 15 mg/kg in 100 ml of saline solution was administered to the test group during the surgery (20 minutes before the end of the surgery). The control group was administered 100 ml of saline solution without TXA. In both groups, the following parameters were evaluated preoperatively and postoperatively (on Day 1 and Day 10 and at 1 month and 3 months): thigh circumference at 1 cm above the patella, Coupens and Yates (CY) score for swelling, and pain score (VAS). At 24 hours after the surgery, the blood loss (secretion into the drain) and decrease in hemoglobin (Hb) and hematocrit (HCT) levels compared to the preoperative levels were assessed. The functional status of the knee joint was assessed based on the Lysholm knee scoring scale and the IKDC subjective knee evaluation form preoperatively, or at 1 and 3 months postoperatively. RESULTS In the test group, a significantly lower blood loss was detected 24 hours after the surgery. The mean difference of 128 ml compared to the control group was both statistically and practically significant (p < 0.001, d =1.42). The test group showed a lower decrease in Hb and HCT levels postoperatively compared to the control group, although with no statistical significance. On the first postoperative day, slightly better results of the thigh circumference at 1 cm above the patella and of the CY score were observed in the test group. However, during the follow-up check performed postoperatively on Day 10, the differences in the thigh circumference at 1 cm above the patella, CY score and pain VAS score were negligible. The differences in the functional status of the knee joint between the two groups ascertained during the check performed 1 month and 3 months after the surgery were insignificant. DISCUSSION Our study, just like other studies, confirms a significant effect of a single dose of intravenous TXA on the volume of blood loss and early postoperative swelling, which are the parameters affecting the early postoperative course. Even though the intervention does not affect the subsequent result of surgery, it can undoubtedly be of benefit perioperatively. There is a fairly limited number of randomised clinical studies on this topic in literature, with most of them published in the last 7 years. Further research should, among other things, optimise the protocol and identify a suitable candidate for TXA administration in patients undergoing an ACL reconstruction. CONCLUSIONS Our study confirmed the positive effect of a single dose of intravenous TXA during the reconstruction of anterior cruciate ligament using hamstrings on early postoperative blood loss and early postoperative swelling, which can have a positive effect on wound healing and prevent postoperative complications. Therefore, in agreement with available literature, we recom mend administering a single dose of intravenous TXA in ACL reconstruction, unless there is a contraindication to this therapy. Key words: anterior cruciate ligament reconstruction, hamstrings tranexamic acid, single intravenous administration, clinical evaluation.

• MeSH
• kolenní kloub chirurgie   MeSH
• kyselina tranexamová * MeSH
• lidé MeSH
• Lysholmovo skóre MeSH
• poranění předního zkříženého vazu * chirurgie   MeSH
• prospektivní studie MeSH
• rekonstrukce předního zkříženého vazu * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

PURPOSE OF THE STUDY The locked nailing of diaphyseal fractures of the tibia currently represents a method of choice for treating the closed diaphyseal fractures, some of the tibial metaphyseal fractures and open tibial diaphyseal fractures classified as grade I and II according to Gustilo-Anderson (GA) classification. The suprapatellar (SP) approach is an alternative technique of insertion of the nail in semi-extension of the lower extremity with easier reduction, namely of multiple fractures and proximal diaphyseal fractures of the tibia in particular. This study aims to evaluate the group of patients in whom the suprapatellar approach was used and who were followed up for the period of at least 12 months. MATERIAL AND METHODS The prospective study included 55 cases of osteosynthesis of diaphyseal fractures of the tibia with the surgery performed in the period from January 2013 to June 2015, of which in 53 patients (17 women and 36 men) with the mean age of 49.6± 16.7 years the ETN nail by DePuy Synthes ® was inserted through a suprapatellar approach. In 38 cases (70.1%) an isolated trauma was involved, 15 patients (29.9%) were treated for multiple injuries or polytrauma. In nine cases (17%) it was an open fracture (2times - GA grade I, 7times - GA grade II). A multiple fracture or a fracture of the proximal third was recorded in 19 cases (34.5%). The functional and radiological results of the treatment were assessed prospectively at 12 months after the surgery using the Lysholm (LS) score. RESULTS The final functional results were successfully assessed in 49 performed osteosyntheses (89.1%). The mean duration of surgery was 72.7± 19.57 min (40-140 min, median 65 min). A total of 48 (98%) fractures healed by primary intention. In five cases (10.2%) a delayed healing occurred and in one case (2 %) non-union was reported, requiring a revision surgery. In three cases (6.1%) complete implant was removed (twice by SP and once by IP approach). The mean Lysholm score was 93.4 ± 8.39 points (59-100 points, median score of 95 points). An excellent or a good result was observed in 45 patients (91.8%), a satisfactory result in three patients (6.2%), and a poor result in one patient (2%). A statistically significant correlation (p = 0.006) between the LS score values and the age of the patients was confirmed. In patients up to 60 years of age the LS score was 96.2 ± 4.51 points (89-100, median 96), at the age of more than 60 years it was 86.9 ± 11.46 (59-100, median 89). CONCLUSIONS The suprapatellar approach in treating the tibial diaphyseal fractures represents a safe alternative nail insertion technique. If an appropriate surgical technique is applied, the risks inherent in this approach are negligible. The approach allows for an easy reduction of challenging fractures of the proximal third diaphyseal fracture of the tibia and multiple fractures of the tibia and facilitates an easy check of the axial position of the extremity. The functional results of the knee joint are comparable to those achieved with the infrapatellar nailing technique. The final LS score correlates with the age of the patients. Key words:tibial fractures, suprapatellar approach, intramedullary nailing, knee pain.

• MeSH
• diafýzy diagnostické zobrazování   zranění   chirurgie   MeSH
• dospělí MeSH
• fraktury tibie klasifikace   diagnostické zobrazování   chirurgie   MeSH
• intramedulární fixace fraktury přístrojové vybavení   metody   MeSH
• kostní hřeby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• Lysholmovo skóre MeSH
• otevřené fraktury diagnostické zobrazování   chirurgie   MeSH
• prospektivní studie MeSH
• radiografie MeSH
• senioři MeSH
• uzavřené fraktury diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH