Affiliation:
1. Connecticut Orthopaedic Specialists, Hamden, Connecticut
2. Yale-New Haven Hospital, New Haven, Connecticut
3. Department of Orthopaedics and Sports Medicine, Oji General Hospital, Hokkaido, Japan
4. Hospital for Special Surgery, New York, New York
Abstract
Background Nonsteroidal anti-inflammatory drugs are commonly prescribed after rotator cuff repair. These agents can impair bone formation, but no studies have evaluated their impact on tendon-to-bone healing. Hypothesis Traditional nonselective nonsteroidal anti-inflammatory drugs and cyclooxygenase-2–specific nonsteroidal antiinflammatory drugs interfere with tendon-to-bone healing. Study Design Controlled laboratory study. Methods One hundred eighty Sprague-Dawley rats underwent acute rotator cuff repairs. Postoperatively, 60 rats received 14 days of celecoxib, a cyclooxygenase-2–specific nonsteroidal anti-inflammatory drug; 60 received indomethacin, a traditional nonselective nonsteroidal anti-inflammatory drug; and 60 received standard rat chow. Animals were sacrificed at 2, 4, and 8 weeks and evaluated by gross inspection, biomechanical testing, histologic analysis, and polarized light microscopy to quantify collagen formation and maturation. Results Five tendons completely failed to heal (4 celecoxib, 1 indomethacin). There were significantly lower failure loads in the celecoxib and indomethacin groups compared with the control groups at 2, 4, and 8 weeks (P< .001), with no significant difference between nonsteroidal anti-inflammatory drug groups. There were significant differences in collagen organization and maturation between the controls and both nonsteroidal anti-inflammatory drug groups at 4 and 8 weeks (P< .001). Controls demonstrated progressively increasing collagen organization during the course of the study (P< .001), whereas the nonsteroidal anti-inflammatory drug groups did not. Conclusion Traditional and cyclooxygenase-2–specific nonsteroidal anti-inflammatory drugs significantly inhibited tendon-tobone healing. This inhibition appears linked to cyclooxygenase-2. Clinical Relevance If the results of this study are verified in a larger animal model, the common practice of administering nonsteroidal anti-inflammatory drugs after rotator cuff repair should be reconsidered.
Subject
Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine
Cited by
258 articles.
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