AI Ranks Epinephrine Irrigation Ahead for Clearer Shoulder Repair

Visibility during rotator cuff surgery was the focus of a secondary analysis of a randomized controlled trial. Researchers compared diluted epinephrine irrigation with intravenous tranexamic acid given before surgery. Each method was tested separately during the glenohumeral and subacromial parts of the procedure.

The study enrolled 82 patients with rotator cuff tears. They were randomly assigned at a one-to-one ratio. One group received epinephrine irrigation at 0.33 mg/L without tranexamic acid. The other received intravenous tranexamic acid at 15 mg/kg without epinephrine irrigation. A pretrained deep learning model scored visual clarity on a three-point scale. It assessed intra-articular evaluation, subacromial debridement, and rotator cuff repair. Researchers also recorded irrigation pump pressure at each stage. They monitored hypotensive bradycardic events and adverse events after surgery.

Epinephrine irrigation received better overall visibility scores. The mean difference was 0.07, with a 95% confidence interval of 0.03 to 0.10 and a P value below 0.001. The gap was clearest during subacromial debridement. Its mean difference was 0.08. A smaller but significant advantage appeared during rotator cuff repair, with a mean difference of 0.03. The epinephrine group also used lower pump pressures. It required fewer pressure increases during the procedure.

Safety findings did not show a significant difference between the groups. The rates of hypotensive bradycardic events and postoperative adverse events were not significantly different. This makes the visibility result more useful, because better imaging was not paired with a detected rise in recorded complications. The study was a secondary analysis and was rated Level II evidence. Within this trial, the data favored diluted epinephrine irrigation for clearer surgical visualization, especially during the subacromial stages.