DG Journal Club
J Shoulder Elbow Surg. 2022 Nov 17
BACKGROUND Tranexamic acid (TXA) was widely used in orthopedic surgery with the aim to reduce intra-/postoperative bleeding and bleeding related complications. The aim of the present study was to assess, whether intra-articular use of TXA during arthroscopic rotator cuff tear (RCT) repair could improve the visual clarity, shorten the duration of operation and provide superior pain management as compared to placebo.
METHODS This study was conducted as prospective, randomized, double-blinded and placebo controlled. Patients with MRI confirmed RCT, above the age of 18 and a history of failed conservative treatment for at least 6 months were included. Patients with a history of coagulopathy, cardiac-renal-hepatic disease and those with a history of conservative treatment less than 6 months and acute RCT were excluded. Visual clarity as the primary outcome was assessed by using arthroscopic visual scale comprising 5 grades ranging from grade 1: best visual clarity, grade 5: worst visual clarity (need to do open surgery) after the procedure by the operating surgeon every 10 minutes throughout the video of the operation. Secondary outcomes were duration of operations and postoperative pain scores.
RESULTS 63 patients were enrolled and randomized into two groups with similar demographic data (age-sex-intraoperative mean arterial pressure): TXA Group comprised 32 patients with a mean age of 56.46. Placebo group comprised 31 patients with a mean age of 57.83. TXA group was reported to have significantly superior visual clarity (mean arthroscopic visual score 1.5±0.5 vs. 2.86±1.7, p=.000) with significantly higher percentage of grade 1 visual clarity (78.1% vs. 32.2%, p=.000) and lower percentage of grade 4 visual clarity (0% vs. 3.2%, p=.003). Grade 5 visual clarity was recorded in none of the patients in either group. TXA group was found to have significantly shorter duration of operation (55.73 vs. 67.26, p=.001) and superior pain scores at the 8thand 24thpostoperative hour (2.3 vs 3.6 and 1.6 vs. 2.4, p=.002 and p=.000). No complications were recorded in either of the groups.
CONCLUSIONS The present study concluded, that during arthroscopic rotator cuff repair procedures, intra-articular use of TXA was able to provide superior arthroscopic visual clarity, while shortening total durations of operations significantly and providing significantly superior pain-management at the first 8thand 24thpostoperative hours as compared to placebo. The present study also underlined the safety and efficacy of intra-articular TXA use in arthroscopic rotator cuff repair.
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