Deep learning assessment of visualization in rotator cuff repair: a secondary analysis of a randomized controlled trial comparing epinephrine irrigation and intravenous tranexamic acid.

BACKGROUND

This study aimed to compare intraoperative visualization between diluted epinephrine (EPN) irrigation and preoperative intravenous tranexamic acid (TXA) during the glenohumeral and subacromial phases of rotator cuff repair.

METHODS

Eighty-two patients with rotator cuff tears were prospectively randomized (1:1) to receive either 0.33 mg/L EPN irrigation without TXA (EPN group) or preoperative intravenous TXA (15 mg/kg) without EPN irrigation (TXA group). Visual clarity was evaluated using a pretrained deep learning model with a 3-point grading scale across three stages: intra-articular assessment, subacromial debridement, and rotator cuff repair. Irrigation pump pressure was recorded at each stage. Hypotensive bradycardic events (HBEs) and postoperative adverse events were monitored.

RESULTS

Overall visual clarity was significantly greater in the EPN group than in the TXA group (mean difference [MD], 0.07; 95% CI, 0.03-0.10; P<0.001). Visualization was superior with EPN during subacromial debridement (MD, 0.08; 95% CI, 0.03-0.13; P=0.001) and rotator cuff repair (MD, 0.03; 95% CI, 0.004-0.06; P=0.02). The EPN group required lower pump pressures and fewer increases in pressure. No significant differences in HBEs or adverse events were observed.

CONCLUSIONS

Diluted EPN irrigation improved intraoperative visualization compared with TXA, particularly during the subacromial phases, without increasing perioperative risk. Deep learning provided objective support for its clinical use. Level of evidence: II.