The Effect of Postoperative NSAID Use on Tendon Healing or Clinical Outcomes After Arthroscopic Rotator Cuff Repair: A Prospective Multicenter Cohort Study
Maurits G. L. Olthof, Maximilian Gressl, Paul Borbas, Andreas M. Mueller, Laurent Audigé, Sebastian A. Mueller, Philipp Moroder, Michael Schär, , Karl WieserBackground:
The clinical effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on tendon-to-bone healing remains uncertain. Preclinical studies have reported both potentially detrimental effects on collagen synthesis and possible benefits through reduced adhesion formation. This study aimed to evaluate the influence of postoperative NSAID intake on tendon integrity, functional outcomes, and patient-reported outcome measures (PROMs) after arthroscopic rotator cuff repair (ARCR).
Hypothesis:
We hypothesized that NSAID use would not affect the risk of retear or clinical outcomes after rotator cuff repair (RCR).
Study Design:
Cohort study; Level of evidence, 2.
Methods:
This analysis included 901 patients from the multicenter cohort who underwent primary arthroscopic supraspinatus repair across 19 orthopaedic centers. Patients were stratified by postoperative NSAID intake. Clinical outcomes were assessed at 6, 12, and 24 months using standardized examinations. Structural failure was defined as any symptomatic or asymptomatic recurrent full-thickness defect confirmed by ultrasound or magnetic resonance imaging (according to the respective hospital protocol) at or beyond 12 months postoperatively. Statistical analyses were performed using generalized linear models and generalized linear mixed models, with adjustment for baseline characteristics and relevant confounders.
Results:
Postoperative NSAID use was not associated with significant differences in functional scores, pain, shoulder-specific PROMs, or general health PROMs. In addition, no effect of NSAID use on postoperative shoulder stiffness was observed after adjustment for baseline passive range of motion (odds ratio [OR], 1.6 [95% CI, 0.91-2.9];
Conclusion:
In this prospectively enrolled, multicenter cohort, postoperative NSAID analgesia did not adversely affect tendon integrity, passive range of motion, functional outcomes, or PROMs after ARCR. These findings suggest that NSAIDs can be incorporated into multimodal postoperative pain management without increasing the risk of tendon retear after ARCR.