The University of Cincinnati will lead a national study that could have a major effect on how people, especially teens, recover from ACL surgery. It will soon begin enrolling patients in a clinical trial.
The study will look at the effectiveness of using a surgical drug post-operatively to speed up recovery. Tranexamic acid (TXA) is already regularly used during surgeries to limit bleeding.
"In this study, we're administering this to patients outside of the operating room in the first week after ACL surgery to try to limit how much bleeding they have in the knee, how much swelling, (and) therefore how much pain they have," David Bernholt, MD, principal investigator and an associate professor of clinical medicine tells WVXU. "The idea is, hopefully, that leads to earlier increases in motion, and can provide a quicker recovery."
Bernholt notes the drug is a generic medication that's cheap, highly accessible and already used in operating rooms.
He's leading the study in collaboration with the University of Pittsburgh, Duke University, Washington University in St. Louis, Endeavor Health in the Chicago area and Campbell Clinic in the Memphis area. The study will enroll 100 participants between the ages of 14 and 22. It's expected to begin enrolling patients in the first quarter of 2026.
Half of the participants will take tranexamic acid orally for seven days following surgery while the other half will be given a placebo. Their recovery will then be tracked for up to a year.
In similar studies of the same drug, post operative use following full knee replacement showed early improvement in pain and motion.
Bernholt says even if that's all researchers find here, it would still be a win. While quicker recovery is the goal, he says, less pain is always better.
"If we see in the group that gets the medication that they are at a higher percentage ready to return to sport at nine months, versus the group that does not, that's what will make this practice changing across the country," he says. "If we can get people back (to their sport) sooner, that's the endpoint that I think really will make people excited about this, although I think people should be excited just by reducing your pain in the first two to six weeks."
For high school athletes, shortening recovery times by as much as four months — nine months of down time for surgery and recovery versus 12 or 13 months — could mean the difference between missing one year of a sport versus two.
"For a high school athlete, if you're talking nine months back versus 13 months back, that's a huge difference. That's potentially two seasons you're out. (For example), if you hurt your knee in October of a fall sport and you take 13 months to get back, your fall sports season for the next year is pretty much gone."
Unlike some clinical studies that take years to move from theory to implementation, Bernholt notes this could have immediate implications. He points out some orthopedic doctors are already recommending post-op use of tranexamic acid. In 2023, a paper on the study of its use in total knee replacement surgeries earned the American Association of Hip and Knee Surgeons (AAHKS) annual Clinical Research Award.
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