Intra-articular versus intravenous tranexamic acid in arthroscopic rotator cuff repair: Arthroscopic visual clarity and early postoperative pain in a propensity score-matched study.

PurposeWe aimed to find the distinctions between IV and IA TXA concerning intraoperative visual clarity, postoperative pain management during ARCR.MethodsIn our retrospective cohort, propensity score matching study, we included patients who had a history of rotator cuff tears and at least six months of unsuccessful conservative treatment. The primary outcome, visual clarity during surgery, was evaluated using a five-grade arthroscopic visual scale (AVS) by the operating surgeon. This scale ranged from grade 1, indicating optimal clarity, to grade 5, the least clarity necessitating a switch to open surgery. These assessments were made at 10-minute intervals during the review of the operation's video footage. We also measured postoperative pain levels as secondary outcomes.ResultsIA group included 30 patients and the IV group had 31 patients, with no significant differences in demographics or tear dimensions (p=0.686). The IA and IV groups showed similar irrigation fluid volumes, operation times, and AVS mean scores. IA group had a higher proportion of favorable AVS grades (grades 1-2) compared to IV group (90.0% vs 64.5%, p=0.011). Pain assessment using the Visual Analog Scales (VAS) were lower in the IA group at 24, 48, and 72 hours postoperatively; however, after Bonferroni correction, only the 48-hour difference remained statistically significant (2.7 vs. 4.2, p=0.008).ConclusionsBoth IA and IV TXA may be useful adjuncts in ARCR. In this propensity score-matched cohort, IA TXA was associated with a higher proportion of favorable AVS grades and a modest short-term pain benefit, with statistical significance only at 48 hours after correction for multiple comparisons. Within the limitations of this study, IA TXA may be considered a reasonable alternative, particularly when IV administration is not suitable.