These authors used a rat model to determine the effect of nonsteroidal antiinflammatory drugs (NSAIDs) on the healing glenoid labrum and capsule after glenohumeral dislocation.
Sixty-six rats had surgically induced anterior-inferior labral tears and anterior glenohumeral dislocation. Postoperatively, the animals were assigned to either normal (n = 32) or ibuprofen drinking water (n = 31). Animals were euthanized at 2 and 4 weeks postoperatively for biomechanical testing and histologic analysis.
They found that the postinjury administration of ibuprofen resulted in decreased capsulolabral healing as indicated by decreased stiffness and maximal load to failure.
and delayed histologic evidence of healing
These authors point to a clinical study investigating the effect of NSAIDs on capsulolabral healing in 477 patients from the Norwegian shoulder instability registry with a primary arthroscopic Bankart procedure (see this link). The Western Ontario Shoulder Instability Index and the reoperation rate of the patients who received NSAIDs postoperatively were not statistically significant from those who did not.
Comment: There are substantial data suggesting that non-steroidal anti-inflammatory medications can interfere with the progress of healing of soft tissue injuries and repairs, fractures and surgical fusions.
On the other hand, these medications are effective non-narcotic analgesics with great utility in the postoperative period. They may also be effective in combatting stiffness after arthroplasty.
In situations where healing is likely to be robust (e.g. in healing the subscapularis repair after a shoulder arthroplasty) we use immediate postoperative NSAIDs because the benefit seems to outweigh the resk.
However, where healing is uncertain, for example in rotator cuff repair, there may be a consideration to avoid these medications, although again the evidence comes primarily from animal models (see this link).
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