Arthroscopic Rotator Cuff Repair Performed with Intra-Articular Tranexamic Acid: Could It Provide Improved Visual Clarity and Less Postoperative Pain? A Prospective, Double-Blind, Randomized Study of 63 Patients

Background: Tranexamic acid (TXA) has been widely used in orthopedic surgery with the aim of reducing intraoperative and postop-erative bleeding, as well as bleeding-related complications. The purpose of this study was to assess whether intra-articular use of TXA during arthroscopic rotator cuff tear (RCT) repair could improve visual clarity, shorten the duration of the operation, and provide su-perior pain management as compared with placebo.Methods: We conducted a prospective, randomized, double-blind, placebo-controlled study. Patients aged >18 years with a magnetic resonance imaging-confirmed RCT and a history of failed conservative treatment for >6 months were included. Patients with a history of coagulopathy; a history of cardiac, renal, or hepatic disease; a history of conservative treatment for <6 months; and/or acute RCTs were excluded. Visual clarity as the primary outcome was assessed using an arthroscopic visual scale comprising 5 grades -ranging from grade 1, best visual clarity, to grade 5, worst visual clarity (requiring conversion to open surgery) -after the procedure by the operating surgeon every 10 minutes throughout the video of the operation. Secondary outcomes were operative duration and postoper-ative pain scores.Results: A total of 63 patients with similar demographic data (age and sex) and intraoperative mean arterial pressure were enrolled and randomized into 2 groups: The TXA group comprised 32 patients with a mean age of 56.46 years, and the placebo group comprised 31 patients with a mean age of 57.83 years. The TXA group was reported to have significantly superior visual clarity (mean arthroscopic visual scale score, 1.5 +/- 0.5 vs. 2.86 +/- 1.7; P <.001), with a significantly higher percentage of grade 1 visual clarity (78.1% vs. 32.2%, P < .001) and a significantly lower percentage of grade 4 visual clarity (0% vs. 3.2%, P = .003). Grade 5 visual clarity was not recorded in any patient in either group. The TXA group showed a significantly shorter operative duration (55.73 minutes vs. 67.26 minutes, P = .001) and superior pain scores at 8 hours (2.3 vs. 3.6, P = .002) and 24 hours (1.6 vs. 2.4, P < .001) postoperatively. No compli-cations were recorded in either group.Conclusions: This study showed that during arthroscopic rotator cuff repair procedures, intra-articular use of TXA was able to provide superior arthroscopic visual clarity while shortening the total operative duration significantly and providing significantly superior pain management in the first 8 and 24 hours postoperatively as compared with placebo. This study underlines the safety and efficacy of intra-articular TXA use in arthroscopic rotator cuff repair.Level of evidence: Level I; Randomized Controlled Trial; Treatment Study (c) 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.