Summary
A randomized controlled trial comparing the outcomes of TXA injection during rotator cuff repair showed better results in term of pain and range of motion than the control group.
Abstract
Purpose
To determine whether subacromial injection of tranexamic acid improves early postoperative range of motion of the shoulder and to assess tendon healing and functions following arthroscopic rotator cuff repair at 2-year postoperative.
Methods
This prospective randomized controlled trial included patients who underwent arthroscopic rotator cuff repair between November 2019 and December 2020. They were randomly assigned to the subacromial tranexamic acid injection (TXA) and control groups. Shoulder range of motion (forward flexion, isolated glenohumeral abduction, external and internal rotation with 90° arm abduction, and external rotation with the arm at side) was measured pre- and postoperatively at 2, 6, and 12 weeks. Postoperative pain was assessed 24 hours after the procedure using the visual analog scale. A magnetic resonance imaging was performed approximately 2 years post-surgery to evaluate healing grading using the Sugaya classification. ASES and constant score were recorded for the functional outcomes.
Results
A total of 62 patients were randomized, with 31 in each group. Forward flexion, isolated glenohumeral abduction, and external rotation with the arm abducted at 90° significantly improved in the tranexamic acid group at 2 weeks (98.48 ± 23.23 vs. 78.42 ± 27.1, P = 0.003; 90.45 ± 16.53 vs. 68.03 ± 19.23, P < 0.001; 52.71 ± 18.58 vs. 36.97 ± 20.71, P = 0.003, respectively), 6 weeks (129.13 ± 14.38 vs. 115.19 ± 23.51, P = 0.007; 105.23 ± 12.02 vs. 90.39 ± 13.28, P < 0.001; 66.48 ± 15.58 vs. 56.16 ± 20.85, P = 0.031, respectively), and 12 weeks postoperatively (145.45 ± 13.68 vs. 134.87 ± 23.44, P = 0.035; 117.74 ± 9.18 vs. 105.71 ± 27.21, P = 0.025; 77.71 ± 9.87 vs. 67.16 ± 15.61, P = 0.003, respectively), along with reduced postoperative pain at 24 hours (4.32 ± 2.79 vs. 2.65 ± 1.7, P = 0.006). 39 people out of a total of 62 (18 in the control group and 21 in the TXA group) were able to enroll for the evaluation of tendon healing. There was no significant difference in tendon healing, the American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Constant shoulder score at 2 years postoperative between the groups. Subgroup analyses for partial and complete tears also revealed no significant differences.
Conclusion
Subacromial injection of tranexamic acid improved early shoulder ROM up to 12weeks postoperatively, reduced postoperative pain at 24hours, and demonstrated no impairment in tendon healing or function following arthroscopic rotator cuff repair at 2 years postoperative.
Level of evidence: Level II, prospective randomized therapeutic trial.