Do Nonsteroidal Anti-Inflammatory Drugs Affect Tissue Healing After Arthroscopic Anterior Cruciate Ligament Reconstruction?

Ge, Heng An; Liu, Centao; Shrestha, Amrit Kumar; Wu, Peng; Cheng, Biao

doi:10.12659/msm.910942

Cited by 10 publications

(17 citation statements)

References 31 publications

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“…Consistent with our work, ketorolac administration following anterior cruciate ligament (ACL) reconstruction was associated with worse outcomes in one study (23). Conversely, another study showed NSAID use was associated with equivalent Visual Analog Scale pain scores and examination one year after operative ACL repair (24). In agreement with our data, prior work has reported that females with Achilles tendon rupture suffer worse outcomes than males (25).…”

Section: Discussionsupporting

confidence: 90%

Non-Steroidal Anti-Inflammatory Drug Use and Recovery after Achilles Tendon Rupture

Franco

Grotts

Lin

et al. 2019

Muscle Ligaments and Tendons J

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Background. The effect of non-steroidal anti-inflammatory drugs (NSAIDs) on recovery after Achilles tendon rupture is unknown. This is the first study examining the relationship between NSAID use and recovery after Achilles tendon rupture in humans. Methods. Adult patients presenting between 01/01/14 and 03/30/2018 with acute Achilles tendon rupture were asked to complete a survey in the Spring of 2018 to determine whether they took NSAIDs after rupture. Their recovery was quantified in three ways: 1) the Achilles Tendon Total Rupture Score (ATRS), 2) the duration of time to walk again normally, and 3) the incidence of tendon re-rupture. Recovery was compared across NSAID and non-NSAID users. Results. Fifty-three percent of 361 patients who completed the survey used NSAIDs following tendon rupture. NSAID users reported a significantly lower ATRS (69) than non-NSAID users (77; p < 0.005). There was no difference in time to walk again normally or incidence of re-rupture. After controlling for age, sex, operative versus non-operative treatment, and time from diagnosis to survey completion, NSAID use was still associated with a significantly lower ATRS (p = 0.003). Conclusion. NSAID use was associated with a lower ATRS after Achilles tendon rupture.

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Section: Discussionsupporting

confidence: 90%

Non-Steroidal Anti-Inflammatory Drug Use and Recovery after Achilles Tendon Rupture

Franco

Grotts

Lin

et al. 2019

Muscle Ligaments and Tendons J

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“…However, although NSAIDs affected the strengthening and tendon healing in these animal studies, a clinical study in humans found that receiving NSAIDs did not affect healing after ACLR. Ge et al 11 evaluated knee stability (measured with an anterior drawer test, Lachman test, pivot-shift test, and KT-2000 arthrometer) and functional outcomes (using the International Knee Documentation Committee Questionnaire, Lysholm score, and Tegner scale) by comparing patients receiving celecoxib or tramadol, and they found no significant differences between the 2 groups in knee stability and functional outcomes at 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Efficacy of Postoperative Pain Control Between Intravenous Parecoxib and Oral Diclofenac in ACL Reconstruction

Chuaychoosakoon

Parinyakhup

Wiwatboworn

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: A nonsteroidal anti-inflammatory drug such as oral diclofenac is normally used to relieve postoperative pain after anterior cruciate ligament reconstruction (ACLR), but most patients continue to have moderate-to-severe pain that disturbs their rehabilitation. Some orthopaedists prefer to use intravenous (IV) parecoxib for postoperative pain control. Purpose: To compare the efficacy of IV parecoxib and oral diclofenac for postoperative pain control in ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively collected and analyzed postoperative pain in patients who underwent both single- and double-bundle ACLR; pain was reported on a 10-point visual analog scale (VAS; 10 = worst pain). After the operation, each patient was given either IV parecoxib twice a day or oral diclofenac 3 times a day, and all patients received paracetamol 6 times per day for 24 hours postoperatively. If the patient complained of moderate or severe pain (VAS >3) after surgery, 3 mg of morphine would be given intravenously every 3 hours and 1 mg of morphine as a rescue analgesic every 1 hour for 24 hours postoperatively. Postoperative VAS and morphine consumption were recorded every 4 hours for 24 hours. Data were analyzed using paired t test, analysis of variance, and chi-square test. Results: Overall, 161 patients were included in this study, of whom 47 received IV parecoxib and 114 received oral diclofenac. The mean VAS scores at 4 and 8 hours postoperatively were 3.5 and 3.4, respectively, in the parecoxib group, and 4.4 and 4.7, respectively, in the diclofenac group. The parecoxib group had significantly lower mean VAS than the diclofenac group at 4 hours ( P = .047) and 8 hours ( P = .005), and the mean cumulative morphine consumption in the parecoxib group was significantly lower than in the diclofenac group at all time points ( P < .05) except 4 hours postoperatively. Conclusion: This study found that IV parecoxib was more effective than oral diclofenac in controlling postoperative pain and resulted in lower postoperative morphine consumption within the first 24 hours after ACLR.

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“…NSAIDs would not be used by 17 (39%), 19 (43%) and 11 (25%) of practitioners in the cases involving female ACL rupture, male and paediatric fractures, respectively. The reasons cited for the avoidance of NSAIDs in the female ACL rupture by 11 (25%) participants and three (7%) participants were “increased risk of bleeding” and “inhibition of wound healing” respectively, despite conflicting evidence in the literature 41 43 . Similar concerns were echoed regarding use of NSAIDs in the male ankle fracture.…”

Section: Discussionmentioning

confidence: 99%

“…in humans [39][40][41][42]. Further research is needed to explore the potential implications on wound and injury healing.…”

Section: Non-steroidal Anti-inflammatory Drugs (Nsaids)mentioning

confidence: 99%

Pitch-side Acute Severe Pain Management Decisions in European Elite Football

Doheny

Bury

2021

Int J Sports Med

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This is the first study on acute severe pain management involving sport and exercise medicine Doctors who are leaders in football medicine in their respective countries. An online survey was designed describing the management of acute severe pain in this expert cohort. The survey captured participant sex, age, years working in sports medicine, core specialty and use of clinical practice guidelines (CPGs). Finally, three clinical vignettes exploring the management of acute pain were presented. Forty-four senior team doctors across 55 European countries completed the survey. There were no consistent guidelines proposed, with 33 (75%) participants indicating they did not use any. Methoxyflurane was proposed by 14 (32%) and 13 (30%) participants for female anterior cruciate ligament rupture and male ankle fracture, respectively. Strong opioids were not used in 17 (39%) and 6 (14%) participants regarding female cruciate injuries and male fractures, respectively. Despite 75% of participants having paediatric life support training, eight (18%) participants expressed uncertainty administering medications in this population, and 15 (34%) would avoid using strong opioids altogether. There is a tendency to undertreat pain and avoid strong opioids for reasons including lack of monitoring equipment, anti-doping concerns and lack of comfort treating paediatric patients with opioids.

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Do Nonsteroidal Anti-Inflammatory Drugs Affect Tissue Healing After Arthroscopic Anterior Cruciate Ligament Reconstruction?

Cited by 10 publications

References 31 publications

Non-Steroidal Anti-Inflammatory Drug Use and Recovery after Achilles Tendon Rupture

Non-Steroidal Anti-Inflammatory Drug Use and Recovery after Achilles Tendon Rupture

Comparing the Efficacy of Postoperative Pain Control Between Intravenous Parecoxib and Oral Diclofenac in ACL Reconstruction

Pitch-side Acute Severe Pain Management Decisions in European Elite Football

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