volume 40 issue 3 pages 930-9400

NSAIDs and COX-2 Inhibitors Do Not Affect Healing After Rotator Cuff Repair - A Systematic Review and Meta Analysis.

Yash Sewpaul 1
Richard Huynh 2
Alexander W. Hartland 3
Brook Leung 4
Kar Hao Teoh 5
2
 
University Hospital Aintree, Liverpool, United Kingdom
3
 
Northampton General hospital, Northampton, United Kingdom
4
 
Royal London Hospital, Whitechapel, London, United Kingdom
5
 
Department of Trauma and Orthopaedic Surgery, Princess Alexandra Hospital, Harlow, United Kingdom
Publication typeJournal Article
Publication date2024-03-01
scimago Q1
wos Q1
SJR2.219
CiteScore9.6
Impact factor5.4
ISSN07498063, 15263231
Orthopedics and Sports Medicine
Abstract

Purpose

To determine whether non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors affect healing rate, functional outcomes, and patient satisfaction after rotator cuff repair.

Methods

Medline, EMBASE, PsychINFO and the Cochrane Library were searched for randomized controlled trials (RCTs) investigating the use of NSAIDs and COX-2 inhibitors after arthroscopic rotator cuff repair. Primary outcomes included healing and retear rate, determined by radiological imaging. Secondary outcomes included shoulder-specific outcome measures and the visual analog scale (VAS). Risk of bias was graded using the Cochrane risk-of-bias v2.0 tool. The GRADE framework was used to assess certainty of findings.

Results

Seven RCTs with a total of 507 patients were included (298 randomized to NSAID/COX-2 vs 209 randomized to control). NSAIDs use did not yield a difference in retear rate (P = .77). NSAIDs were shown to significantly reduce pain in the perioperative period (P = .01); however, no significant difference was present at a minimum of 6 months (P = .11). COX-2 inhibitors did not significantly reduce pain (P = .15). Quantitative analysis of ASES and UCLA scores showed NSAIDs significantly improved functional outcomes versus control (P = .004). COX-2 inhibitors did not significantly improve functional outcomes (P = .15). Two trials were deemed "low" risk of bias, four trials were graded to have "some concerns", and one trial was graded to have "high" risk of bias. Retear rate and functional PROMs were deemed to have "low" certainty. VAS pain scale was graded to have "moderate" certainty.

Conclusions

This systematic review and meta-analysis indicates that NSAIDs do not affect healing rate after arthroscopic rotator cuff repair, but they do significantly improve postoperative pain and functional outcomes. No significant difference was seen in pain or functional outcomes with the use of COX-2 inhibitors.

Level of Evidence

Level I, meta-analysis of randomized controlled trials.
Found 
Found 

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GOST Copy
Sewpaul Y. et al. NSAIDs and COX-2 Inhibitors Do Not Affect Healing After Rotator Cuff Repair - A Systematic Review and Meta Analysis. // Arthroscopy - Journal of Arthroscopic and Related Surgery. 2024. Vol. 40. No. 3. pp. 930-9400.
GOST all authors (up to 50) Copy
Sewpaul Y., Huynh R., Hartland A. W., Leung B., Teoh K. H., Rashid M. NSAIDs and COX-2 Inhibitors Do Not Affect Healing After Rotator Cuff Repair - A Systematic Review and Meta Analysis. // Arthroscopy - Journal of Arthroscopic and Related Surgery. 2024. Vol. 40. No. 3. pp. 930-9400.
RIS |
Cite this
RIS Copy
TY - JOUR
DO - 10.1016/j.arthro.2023.10.048
UR - https://linkinghub.elsevier.com/retrieve/pii/S0749806323009143
TI - NSAIDs and COX-2 Inhibitors Do Not Affect Healing After Rotator Cuff Repair - A Systematic Review and Meta Analysis.
T2 - Arthroscopy - Journal of Arthroscopic and Related Surgery
AU - Sewpaul, Yash
AU - Huynh, Richard
AU - Hartland, Alexander W.
AU - Leung, Brook
AU - Teoh, Kar Hao
AU - Rashid, Mustafa
PY - 2024
DA - 2024/03/01
PB - Elsevier
SP - 930-9400
IS - 3
VL - 40
PMID - 37967731
SN - 0749-8063
SN - 1526-3231
ER -
BibTex |
Cite this
BibTex (up to 50 authors) Copy
@article{2024_Sewpaul,
author = {Yash Sewpaul and Richard Huynh and Alexander W. Hartland and Brook Leung and Kar Hao Teoh and Mustafa Rashid},
title = {NSAIDs and COX-2 Inhibitors Do Not Affect Healing After Rotator Cuff Repair - A Systematic Review and Meta Analysis.},
journal = {Arthroscopy - Journal of Arthroscopic and Related Surgery},
year = {2024},
volume = {40},
publisher = {Elsevier},
month = {mar},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0749806323009143},
number = {3},
pages = {930--9400},
doi = {10.1016/j.arthro.2023.10.048}
}
MLA
Cite this
MLA Copy
Sewpaul, Yash, et al. “NSAIDs and COX-2 Inhibitors Do Not Affect Healing After Rotator Cuff Repair - A Systematic Review and Meta Analysis..” Arthroscopy - Journal of Arthroscopic and Related Surgery, vol. 40, no. 3, Mar. 2024, pp. 930-9400. https://linkinghub.elsevier.com/retrieve/pii/S0749806323009143.