{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:38:29Z","timestamp":1792564709740,"version":"4.5.0"},"reference-count":0,"publisher":"Korean Shoulder and Elbow Society","content-domain":{"domain":["cisejournal.org"],"crossmark-restriction":true},"short-container-title":["Clin Shoulder Elb"],"abstract":"<jats:p>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\u20130.10; P&lt;0.001). Visualization was superior with EPN during subacromial debridement (MD, 0.08; 95% CI, 0.03\u20130.13; P=0.001) and rotator cuff repair (MD, 0.03; 95% CI, 0.004\u20130.06; 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.<\/jats:p>","DOI":"10.5397\/cise.2026.00395","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T05:39:36Z","timestamp":1792561176000},"update-policy":"https:\/\/doi.org\/10.5397\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Deep learning assessment of visualization in rotator cuff repair: a secondary analysis of a randomized controlled trial comparing epinephrine irrigation and intravenous tranexamic acid"],"prefix":"10.5397","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6324-1934","authenticated-orcid":true,"given":"Son Quang","family":"Tran","sequence":"first","affiliation":[{"name":"Clinical Sciences Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Department of Orthopaedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5721-8479","authenticated-orcid":true,"given":"Minh Cong","family":"Bui","sequence":"additional","affiliation":[{"name":"Clinical Sciences Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Department of Orthopaedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3971-8901","authenticated-orcid":true,"given":"Thun","family":"Itthipanichpong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Sports Medicine Research Group, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5293-5428","authenticated-orcid":true,"given":"Danaithep","family":"Limskul","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Sports Medicine Research Group, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanathep","family":"Tanpowpong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Sports Medicine Research Group, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7045-3222","authenticated-orcid":true,"given":"Napatpong","family":"Thamrongskulsiri","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Sports Medicine Research Group, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3351","published-online":{"date-parts":[[2026,10,21]]},"container-title":["Clinics in Shoulder and Elbow"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/cisejournal.org\/upload\/pdf\/cise-2026-00395.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T05:39:36Z","timestamp":1792561176000},"score":1,"resource":{"primary":{"URL":"http:\/\/cisejournal.org\/journal\/view.php?doi=10.5397\/cise.2026.00395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":0,"URL":"https:\/\/doi.org\/10.5397\/cise.2026.00395","relation":{},"ISSN":["2288-8721"],"issn-type":[{"value":"2288-8721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]},"assertion":[{"value":"2026-04-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-21","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}}]}}