The safety and efficacy of tranexamic acid on visual clarity in arthroscopic rotator cuff repair:a Meta-analysis
MENG Shuo
CAO Chun-feng
WEI Zhi-hui
ZHAO Bo
ZHANG Ming-hua
Abstract：Objective To explore he safety and efficacy of tranexamic acid(TXA)during arthroscopic procedures of arthroscopic rotator cuff repair.Methods A thorough computerized search was conducted in databases such as MEDLINE,EMBASE,Cochrane Library,PubMed,and Clinicaltrials.gov,focusing on randomized controlled trials studying TXA in arthroscopic rotator cuff repair up to June 30,2023.Evaluation metrics included Arthroscopic Visual Score(AVS),Visual Analog Scale(VAS),percentage of optimal vision,surgical time,mean arterial pressure,irrigation volume,frequency of blood pressure changes,postoperative pain,and complications.A Meta-analysis was conducted using RevMan 5.4.1 software.Sensitivity assessments were performed with Stata 12.0,and risk of bias was assessed using the Cochrane ROB2 tool.Subgroup analyses for different TXA application methods were also conducted.Results Eight randomized controlled trials involving 596 patients were included.Of these,302 patients received TXA intervention,and 294 served as the control group.Six studies used intravenous TXA,and two studies used TXA mixed with lavage fluid.The results showed that the AVS score was significantly increased when TXA was mixed with lavage fluid[MD=1.36,95％CI(0.75-1.97),P＜0.0001].It reduced operation time[MD=-11.53,95％CI(-15.48--7.58),P＜0.000 01]and relieved postoperative pain[MD=-0.80,95％CI(-1.24--0.36),P=0.0003].However,intravenous TXA only improved the percentage of good visual acuity[MD=9.10,95％CI(4.05,14.15),P=0.0004]and reduced the operation time[MD=-12.97,95％CI(-18.81--6.93),P＜0.001].There was no significant difference in AVS score[MD=0.13,95％CI(-0.06-0.32),P=0.18]and VAS score[MD=0.07,95％CI(-0.31-0.44),P=0.73].In addition,there was no significant difference in mean arterial pressure[MD=-1.48,95％CI(-3.09-0.14),P=0.07],irrigation requirement[MD=-2.33,95％CI(-5.14-0.74),P=0.14],and number of blood pressure changes[MD=-0.86,95％CI(-1.88-0.16),P=0.10]between the two groups.No adverse event was reported in either group,indicating that TXA did not increase the risk of thromboembolic complications and infections.Conclusions In arthroscopic rotator cuff repair,low-dose TXA mixed with lavage can significantly improve intraoperative visual field clarity,reduce blood loss and shorten operative time,while not increasing the occurrence of adverse events such as blood pressure fluctuation,thrombosis,and infection.It suggests that TXA can be used as a valuable adjunct in arthroscopic rotator cuff repair by mixing it with lavage fluid.
Keywords：Tranexamic acidRotator cuff injuriesArthroscopesMeta-analysis
Publication Date：2024-11-19
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：12( 932-943 )