Association of Subacromial Tranexamic Acid Injection With Better Early Range of Motion and No Significant Difference in 2-Year MRI Tendon Integrity After Arthroscopic Rotator Cuff Repair: Randomized Controlled Trial
Thun Itthipanichpong, Kittitat Jaidee, Napol Tangboonnitiwong, Watcharapon Phoemphunkunarak, Danaithep Limskul, Napatpong Thamrongskulsiri, Somsak Kuptniratsaikul, Thanathep TanpowpongBackground:
Postoperative shoulder pain and stiffness are frequent complications after arthroscopic rotator cuff repair and can adversely affect functional outcomes. Tranexamic acid (TXA) is widely used in orthopaedic surgery to reduce postoperative bleeding and pain, prompting interest in its role in improving early recovery after surgery; however, its local use in rotator cuff repair has raised concerns regarding potential effects on tendon integrity.
Purpose:
To determine whether subacromial injection of TXA is associated with better early postoperative shoulder range of motion (ROM) and lower postoperative pain scores, and to assess magnetic resonance imaging (MRI) tendon integrity and functional outcomes at 2 years after arthroscopic rotator cuff repair.
Study Design:
Randomized controlled trial; Level of evidence, 2.
Methods:
In this prospective randomized controlled trial (November 2019-December 2020), patients undergoing arthroscopic rotator cuff repair were assigned to either a subacromial TXA injection or a control group. Shoulder ROM was assessed preoperatively and at 2, 6, and 12 weeks postoperatively. Pain was evaluated at 24 hours using a visual analog scale. At 2 years, tendon integrity was assessed via MRI using the Sugaya classification, and functional outcomes were measured with the American Shoulder and Elbow Surgeons Shoulder Score (ASES) and Constant scores.
Results:
A total of 62 patients were randomized (31 per group). The TXA group had significantly greater forward flexion, glenohumeral abduction, and external rotation with the arm abducted at 90° at 2, 6, and 12 weeks postoperatively compared with the control group, and lower 24-hour postoperative pain scores (
Conclusion:
Subacromial injection of TXA was associated with improved early shoulder ROM up to 12 weeks postoperatively and lower 24-hour postoperative pain scores compared with the control group. Among patients with available 2-year follow-up, no statistically significant between-group differences were observed in MRI tendon integrity or final functional outcomes.
Trial Registration:
Thai Clinical Trials Registry (TCTR20210530002).