The impact of tranexamic acid on surgical efficiency and visualization in arthroscopic rotator cuff repair: a systematic review and meta-analysis.

Abstract

Tranexamic acid (TXA) is widely used to reduce bleeding and transfusion requirements during orthopedic procedures. The objective of this review was to evaluate the efficacy of TXA in the arthroscopic repair of rotator cuff tears. This systematic review and meta-analysis focused exclusively on randomized controlled trials, sourcing data from Medline, Embase, Web of Science, Scopus, and Cochrane Central up to January 2025. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and evaluated parameters such as visualization in the surgical field, pain, function, total operation time, mean arterial pressure, amount of fluid lost, hospital stay, tear size, and complications. Initially, 298 records were identified. After a comprehensive screening process, 12 studies involving 967 patients were selected for inclusion. Most of the included studies used a saline solution as the control, and the most common route of TXA administration was intravenous, with a dose of 1,000 mg diluted in 100 mL of solution. In the parameters evaluated, no significant differences were found favoring the use of TXA. There was limited comparability of the results reported across the included studies. This study finds a lack of clear evidence to support a clinical benefit of TXA in arthroscopic rotator cuff repair. Consequently, the routine use of TXA for this procedure should be reconsidered. Given its established safety profile, TXA might still have a role in specific, limited clinical situations in which its benefits could outweigh the current lack of evidence for its widespread application. Level of evidence: I.