This systematic review and meta-analysis included 7 randomized controlled trials with 510 patients undergoing arthroscopic rotator cuff repair. The intervention group received tranexamic acid (TXA), and outcomes were compared to controls without TXA administration. Pooled outcomes assessed were visual clarity, postoperative pain (VAS), operative time, and shoulder swelling. Results showed significant reductions in postoperative pain and operative time with TXA use, although pain reduction was not clinically significant. Shoulder swelling and visual clarity outcomes were inconclusive. The study concludes that TXA reduces postoperative pain and operative time without significant adverse effects but highlights the need for further research to assess its impact on visual clarity and other outcomes.