Non-selective NSAIDs do not increase retear rates post-arthroscopic rotator cuff repair: A meta-analysis

Shawn J S Seah; Mark H X Yeo; Cheryl Gatot; Denny Lie

doi:10.1016/j.jisako.2023.04.001

Non-selective NSAIDs do not increase retear rates post-arthroscopic rotator cuff repair: A meta-analysis

J ISAKOS. 2023 Aug;8(4):216-226. doi: 10.1016/j.jisako.2023.04.001. Epub 2023 Apr 19.

Authors

Shawn J S Seah¹, Mark H X Yeo¹, Cheryl Gatot², Denny Lie³

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore.
² Department of Orthopedic Surgery, Singapore General Hospital, 169608, Singapore.
³ Department of Orthopedic Surgery, Singapore General Hospital, 169608, Singapore. Electronic address: dennyttlie@gmail.com.

PMID: 37085034
DOI: 10.1016/j.jisako.2023.04.001

Abstract

Background: Arthroscopic rotator cuff repairs (RCRs) are known to be associated with substantial pain and post-operative pain management is critical in overall patients' outcomes. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used oral medications and can reduce opioid usage. However, controversies arise due to its postulated effect on postoperative tendon healing. As the evidence of safety and efficacy of NSAIDs remains unclear, this study aims to investigate the effect of NSAIDs on retear rates and clinical outcomes.

Methods: A systematic search of four databases (PubMed, EMBASE, Scopus, and Cochrane Library) was conducted, identifying studies that compared cohorts with post-RCR NSAIDs use versus control groups without NSAID use. Meta-analysis was conducted for retear rate as well as pain and functional outcomes (Visual Analogue Scale and American Shoulder and Elbow Surgeons Shoulder score). Subgroup analysis was conducted for retear rates to determine the overall treatment effect of including selective COX-2 inhibitors.

Results: Six studies were included in the meta-analysis. The total baseline cohort size was 916, with 443 (48.3%) patients in the NSAID group and 473 (51.6%) patients in the control group. There were no statistically significant differences in the baseline characteristics between the two groups. Meta-analysis between the two groups showed that there were no statistically significant differences in retear rates (p = 0.70), early and late post-operative Visual Analogue Scale score (p = 0.10 and p = 0.10, respectively) and latest American Shoulder and Elbow Surgeons Shoulder score (p = 0.31). However, subgroup analysis of retear rates revealed a statistically significant difference between the subgroup including COX-2 selective inhibitor versus non-selective COX inhibitor (p < 0.01).

Conclusion: NSAID use in post-arthroscopic RCR pain relief does not increase retear rates and can provide similar clinical outcomes compared to a non-NSAID regimen.

Level of evidence: Meta-analysis, level of evidence, 4.

Keywords: Arthroscopic rotator cuff repair; NSAIDs; Pain management; Retear rates; Rotator cuff tears.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Cyclooxygenase 2 Inhibitors
Humans
Pain
Rotator Cuff Injuries* / drug therapy
Rotator Cuff Injuries* / surgery
Rotator Cuff* / surgery
Treatment Outcome

Substances

Cyclooxygenase 2 Inhibitors