Non-steroidal anti-inflammatory drugs (NSAIDs) are powerful analgesics and can provide an important mode of pain management after surgery (see Nonsteroidal antiinflammatory drugs (NSAID) - are we using them enough?).
There has been concern, however, that NSAIDs may interfere with healing of tendon repair to bone as in rotator cuff repair or subscapularis repair after shoulder arthroplasty (see Do anti inflammatory medications interfere with healing? and Should patients take anti-inflammatory medications after rotator cuff repair?)
Selective COX-2 inhibitors are a class of NSAIDs that reduce the risk of peptic ulceration, which can be a problem with the non-selective NSAIDS. However, clinical trials have revealed that COX-2 inhibitors significantly increase the risk of heart attacks and strokes. For that reason, most COX-2 inhibitors have been removed from the market, only Celebrex (generic name of celecoxib) is still available for purchase in the United States.
In addition to concerns about heart attacks and strokes, there is a particular concern about the effect of selective COX-2 inhibitors, such as Celebrex, on tendon healing (see Does Celebrex interfere with tendon healing?).
The authors of Non-selective NSAIDs do not increase retear rates post-arthroscopic rotator cuff repair: A meta-analysis sought to investigate the effect of postoperative NSAIDs on retear rates and clinical outcomes for cuff repair.
They included 6 studies in their meta-analysis 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 early and late post-operative VAS scores and latest ASES score. In the NSAID group, the pooled retear rate was 25%; in the control group, the pooled retear rate was 21%. Meta-analysis of odds ratio did not yield any statistical significance between the two groups.
However, they conducted a subgroup analysis which demonstrated that inclusion of selective COX-2 inhibitors (‘COX-2 only OR both’ subgroup) leads to significantly higher retear rates when compared to non-selective COX inhibitors (‘Non-selective COX only’ subgroup).
We asked ChatGPT "why do COX-2 drugs interfere with soft tissue healing? " Its response is quoted below
"COX-2 drugs, also known as selective COX-2 inhibitors or nonsteroidal anti-inflammatory drugs (NSAIDs), have been associated with potential interference in soft tissue healing. While the exact mechanisms are not fully understood, several factors contribute to this phenomenon:
Inhibition of prostaglandin synthesis: COX-2 inhibitors selectively block the enzyme cyclooxygenase-2 (COX-2), which is responsible for the production of prostaglandins. Prostaglandins play a crucial role in the inflammatory response and are involved in various stages of tissue healing, including inflammation, angiogenesis (formation of new blood vessels), and collagen synthesis. By inhibiting prostaglandin synthesis, COX-2 inhibitors can disrupt these processes, potentially slowing down tissue healing.
Impaired inflammation response: Inflammation is a necessary and natural part of the healing process, as it helps to clear away damaged tissues, recruit immune cells, and initiate tissue repair. COX-2 inhibitors, by reducing the production of prostaglandins, can dampen the inflammatory response. While this anti-inflammatory effect may be beneficial in controlling pain and swelling, it can also interfere with the timely and appropriate inflammatory phase of healing, potentially impacting tissue repair and regeneration.
Altered angiogenesis: Angiogenesis is a critical step in tissue healing, as it brings oxygen and nutrients to the healing site, aiding in the formation of new blood vessels. Prostaglandins, which are inhibited by COX-2 drugs, play a role in promoting angiogenesis. By reducing prostaglandin levels, COX-2 inhibitors may interfere with the proper formation of blood vessels, negatively impacting tissue healing.
Collagen synthesis disruption: Collagen is the main structural component of soft tissues, providing strength and stability. Prostaglandins are involved in collagen synthesis, and their inhibition by COX-2 drugs can disrupt the proper formation and organization of collagen fibers. This interference can affect the tensile strength and integrity of the healing tissue."
You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.
Follow on twitter: https://twitter.com/shoulderarth
Follow on facebook: click on this link
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
"COX-2 drugs, also known as selective COX-2 inhibitors or nonsteroidal anti-inflammatory drugs (NSAIDs), have been associated with potential interference in soft tissue healing. While the exact mechanisms are not fully understood, several factors contribute to this phenomenon:
Inhibition of prostaglandin synthesis: COX-2 inhibitors selectively block the enzyme cyclooxygenase-2 (COX-2), which is responsible for the production of prostaglandins. Prostaglandins play a crucial role in the inflammatory response and are involved in various stages of tissue healing, including inflammation, angiogenesis (formation of new blood vessels), and collagen synthesis. By inhibiting prostaglandin synthesis, COX-2 inhibitors can disrupt these processes, potentially slowing down tissue healing.
Impaired inflammation response: Inflammation is a necessary and natural part of the healing process, as it helps to clear away damaged tissues, recruit immune cells, and initiate tissue repair. COX-2 inhibitors, by reducing the production of prostaglandins, can dampen the inflammatory response. While this anti-inflammatory effect may be beneficial in controlling pain and swelling, it can also interfere with the timely and appropriate inflammatory phase of healing, potentially impacting tissue repair and regeneration.
Altered angiogenesis: Angiogenesis is a critical step in tissue healing, as it brings oxygen and nutrients to the healing site, aiding in the formation of new blood vessels. Prostaglandins, which are inhibited by COX-2 drugs, play a role in promoting angiogenesis. By reducing prostaglandin levels, COX-2 inhibitors may interfere with the proper formation of blood vessels, negatively impacting tissue healing.
Collagen synthesis disruption: Collagen is the main structural component of soft tissues, providing strength and stability. Prostaglandins are involved in collagen synthesis, and their inhibition by COX-2 drugs can disrupt the proper formation and organization of collagen fibers. This interference can affect the tensile strength and integrity of the healing tissue."
You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.
Follow on twitter: https://twitter.com/shoulderarth
Follow on facebook: click on this link
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
