Impact of Intra-articular Injection with Tranexamic Acid on Total Blood Loss and Postoperative Pain After Arthroscopic Rotator Cuff Repair Surgery

Overview

Journal Front Surg

Specialty General Surgery

Date 2023 Mar 13

PMID 36911608

Authors

Rangteng Zhu

Hantao Jiang

Wei Xu

Liping Shen

Gang Jin

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate the impact of intra-articular injection with tranexamic acid (TXA) on total blood loss (TBL) and postoperative pain after arthroscopic rotator cuff repair (ARCR).

Methods: This study retrospectively included patients with full-thickness rotator cuff tears who underwent shoulder ARCR surgery in Taizhou hospital, China, between January 2018 and December 2020. Patients received 10 ml (100 mg/ml) of intra-articular TXA injection (TXA group) or 10 ml of normal saline (non-TXA group) after the incision was sutured. The primary variable was the type of drug injected into the shoulder joint at the end of the operation. The primary outcome were perioperative TBL and postoperative pain [measured by visual analog scale (VAS)]. The secondary outcomes were differences in red blood cell count, hemoglobin count, hematocrit, platelet count.

Results: A total of 162 patients were included, 83 patients in TXA group and 79 patients in non-TXA group. Notably, patients in TXA group were more likely to have lower TBL volume [261.21 (175.13-506.67) ml vs. 382.41 (236.11-593.31), = 0.025], and postoperative VAS score ≤ 2 within 24 h ( = 0.031) compared with those in non-TXA group. In addition, the median hemoglobin count difference was significantly lower in TXA group than that of in non-TXA group ( = 0.045), while, the differences in median counts of red blood cell, hematocrit, and platelet between the two groups were comparable (all > 0.05).

Conclusion: Intra-articular injection of TXA might reduce the TBL and degree of postoperative pain within 24 h after shoulder arthroscopy.

Citing Articles

A therapeutic assessment of tranexamic acid on functional recovery after rotator cuff repair surgery: A study of early and mid-term follow-up.

Guo J, Que M, Guo J, Liu Z, Che Y J Orthop. 2025; 67:177-182.

PMID: 40051640 PMC: 11880330. DOI: 10.1016/j.jor.2025.02.006.

Efficacy of tranexamic acid in improving visual clarity and operative time of arthroscopic rotator cuff repair: A systematic review and meta-analysis.

Qian Y, Jiang A, Yan J, Zhang S, Zhu S Acta Orthop Traumatol Turc. 2025; 58(6):318-325.

PMID: 39873591 PMC: 11740232. DOI: 10.5152/j.aott.2024.24008.

The Effect of Postoperative Tranexamic Acid and Dexamethasone on Quality of Recovery After Arthroscopic Rotator Cuff Repair: a Double-Blinded, Randomized Controlled Trial.

Jiang X, Xu C, Yuan C, Gao W, Liu W, Wang Y J Pain Res. 2025; 18:259-270.

PMID: 39867540 PMC: 11759578. DOI: 10.2147/JPR.S497297.

References

Calvo E, Rebollon C, Itoi E, Imhoff A, Savoie F, Arce G . Reliable interobserver and intraobserver agreement of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system of rotator cuff tears. J ISAKOS. 2022; 7(2):56-61. DOI: 10.1016/j.jisako.2021.12.004. View

Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad F, Mason J . A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J. 2014; 96-B(8):1005-15. DOI: 10.1302/0301-620X.96B8.33745. View

Wang H, Shen B, Zeng Y . Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials. Knee. 2014; 21(6):987-93. DOI: 10.1016/j.knee.2014.09.010. View

Sun X, Dong Q, Zhang Y . Intravenous versus topical tranexamic acid in primary total hip replacement: A systemic review and meta-analysis. Int J Surg. 2016; 32:10-8. DOI: 10.1016/j.ijsu.2016.05.064. View

Camarasa M, Olle G, Serra-Prat M, Martin A, Sanchez M, Ricos P . Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth. 2006; 96(5):576-82. DOI: 10.1093/bja/ael057. View

Good L, Peterson E, Lisander B . Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003; 90(5):596-9. DOI: 10.1093/bja/aeg111. View

Ahmed S, Ahmed A, Ahmad S, Javed S, Aziz A . Blood loss after intraarticular and intravenous tranexamic acid in total knee arthroplasty. J Pak Med Assoc. 2018; 68(10):1434-1437. View

Goldstein K, Jones C, Kay J, Shin J, de Sa D . Tranexamic Acid Administration in Arthroscopic Surgery Is a Safe Adjunct to Decrease Postoperative Pain and Swelling: A Systematic Review and Meta-analysis. Arthroscopy. 2021; 38(4):1366-1377.e9. DOI: 10.1016/j.arthro.2021.10.001. View

Chen T, Chen Y, Jiao J, Wang Y, Qian L, Guo Z . Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017; 12(1):11. PMC: 5244538. DOI: 10.1186/s13018-017-0512-4. View

10.

Belk J, McCarty E, Houck D, Dragoo J, Savoie F, Thon S . Tranexamic Acid Use in Knee and Shoulder Arthroscopy Leads to Improved Outcomes and Fewer Hemarthrosis-Related Complications: A Systematic Review of Level I and II Studies. Arthroscopy. 2020; 37(4):1323-1333. DOI: 10.1016/j.arthro.2020.11.051. View

11.

Salzler M, Lin A, Miller C, Herold S, Irrgang J, Harner C . Complications after arthroscopic knee surgery. Am J Sports Med. 2013; 42(2):292-6. DOI: 10.1177/0363546513510677. View

12.

Sun Y, Xiao D, Fu W, Cai W, Huang X, Li Q . Efficacy and Safety of Tranexamic Acid in Shoulder Arthroscopic Surgery: A Systematic Review and Meta-Analysis. J Clin Med. 2022; 11(23). PMC: 9738808. DOI: 10.3390/jcm11236886. View

13.

Tengborn L, Blomback M, Berntorp E . Tranexamic acid--an old drug still going strong and making a revival. Thromb Res. 2015; 135(2):231-42. DOI: 10.1016/j.thromres.2014.11.012. View

14.

Bahl V, Goyal A, Jain V, Joshi D, Chaudhary D . Effect of haemarthrosis on the rehabilitation of anterior cruciate ligament reconstruction--single bundle versus double bundle. J Orthop Surg Res. 2013; 8:5. PMC: 3605399. DOI: 10.1186/1749-799X-8-5. View

15.

Huberty D, Schoolfield J, Brady P, Vadala A, Arrigoni P, Burkhart S . Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy. 2009; 25(8):880-90. DOI: 10.1016/j.arthro.2009.01.018. View

16.

Felli L, Revello S, Burastero G, Gatto P, Carletti A, Formica M . Single Intravenous Administration of Tranexamic Acid in Anterior Cruciate Ligament Reconstruction to Reduce Postoperative Hemarthrosis and Increase Functional Outcomes in the Early Phase of Postoperative Rehabilitation: A Randomized Controlled Trial. Arthroscopy. 2019; 35(1):149-157. DOI: 10.1016/j.arthro.2018.07.050. View

17.

Chiang E, Chen K, Wang S, Ma H, Chang M, Liu C . Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study. Arthroscopy. 2019; 35(7):2127-2132. DOI: 10.1016/j.arthro.2019.02.018. View

18.

Zhang P, Liang Y, Chen P, Fang Y, He J, Wang J . Intravenous versus topical tranexamic acid in primary total hip replacement: A meta-analysis. Medicine (Baltimore). 2016; 95(50):e5573. PMC: 5268036. DOI: 10.1097/MD.0000000000005573. View

19.

Liu Y, Hong C, Hsu K, Kuan F, Chen Y, Yeh M . Intravenous Administration of Tranexamic Acid Significantly Improved Clarity of the Visual Field in Arthroscopic Shoulder Surgery. A Prospective, Double-Blind, and Randomized Controlled Trial. Arthroscopy. 2019; 36(3):640-647. DOI: 10.1016/j.arthro.2019.10.020. View

20.

Novoa-Boldo A, Gulotta L . Expectations Following Rotator Cuff Surgery. Curr Rev Musculoskelet Med. 2018; 11(1):162-166. PMC: 5825351. DOI: 10.1007/s12178-018-9470-7. View