Tranexamic Acid Can Reduce Early Tendon Adhesions After Rotator Cuff Repair and Is Not Detrimental to Tendon-Bone Healing: A Comparative Animal Model Study

Abstract

PurposeTo determine the effects of topical tranexamic acid (TXA) administration on tendon adhesions, shoulder range of motion (ROM), and tendon healing in an acute rotator cuff (RC) repair rat model. MethodsA total of 20 Sprague–Dawley rats were used. Tendon adhesion, ROM, and biomechanical and histological analysis of tendon-bone healing were conducted at three and six weeks after surgery. The rats underwent rotator cuff repair surgery on both shoulders and were administered TXA via subacromial injections. The tendon adhesion was evaluated macroscopically and histologically. Biomechanical tendon healing was measured using a universal testing machine, and histological analysis was quantified by Hematoxylin & Eosin, Masson’s trichrome, and picrosirius red staining. ResultsAt three weeks after surgery, the adhesion score was significantly lower in the TXA group (2.10 ± 0.32) than in the control group (2.70 ± 0.48, P = .005), but there was no significant difference between the two groups at six weeks. Regarding the ROM, the TXA group showed a significantly higher external rotation (TXA; 36.35° ± 4.52°, Control; 28.42° ± 4.66°, p= .000) and internal rotation (TXA; 45.35° ± 9.36°, Control; 38.94° ± 5.23°, P = .013) than the control group three weeks after surgery. However, at six weeks, there were no significant differences in external and internal rotation between the two groups. In the biomechanical analysis, no significant differences in gross examination (3 weeks; P = .175, 6 weeks: P = .295), load-to-failure (3 weeks; P = .117, 6 weeks; P = .295), and ultimate stress (3 weeks; P = .602, 6 weeks; P = .917) were noted between the two groups three and six weeks after surgery. In the histological analysis of tendon healing, no significant differences in the total score (3 weeks; P = .323, 6 weeks; P = .572) were found between the two groups three and six weeks after surgery. ConclusionThe topical TXA administration showed a beneficial effect in reducing tendon adhesions and improving ROM at three weeks postoperatively and had no effect at six weeks. This suggests that additional intervention with TXA may be useful to achieve long-term improvement in shoulder stiffness. Additionally, TXA may increase tissue ground substance accumulation in the late postoperative period but does not adversely affect tendon-bone interface healing. Clinical RelevanceThe use of TXA after RC repair has no effect on tendon-bone interface healing in clinical practice and can improve shoulder stiffness in the early postoperative period. Additional research is needed on the long-term effects.