The Effect of Ketorolac on Anteroposterior Knee Laxity After Anterior Cruciate Ligament Reconstruction

Abstract

Level III, retrospective comparative study.

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

“…The authors reported no difference in recovery with NSAID use; however, the sample size was small, the drug selection was atypical, the follow-up time point was early, and the study did not involve patients with Achilles tendon rupture. 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).…”

Pain Management After Outpatient Anterior Cruciate Ligament Reconstruction

“…107 One retrospective analysis linked ketorolac to an increase in anteriorposterior knee laxity after ACL reconstruction with a BPTB autograft. 82 Although the risk of impaired healing warrants further investigation, we view NSAIDs as a safe, low-cost alternative to oral opioids and prescribe them to our patients for the first 5 days postoperatively. Gabapentin 83 and zolpidem 112 are additional oral medications that can be beneficial in reducing opioid consumption postoperatively.…”

The Effect of Limited Perioperative Nonsteroidal Anti-inflammatory Drugs on Patients Undergoing Anterior Cruciate Ligament Reconstruction

“…In a retrospective study, Mehta and co-workers reported increased laxity at 6 weeks in patients treated with ketorolac following ACL reconstruction. 231 Furthermore, Pullen et al found a small, but significantly increased risk for revision associated with NSAIDs following ACL reconstruction in active military personnel; 232 the estimated median duration of use was 30 days (IQR: 14-30), which is considerably longer than the mean of 6.7 days in our cohort. From experimental studies, we know that both the timing and duration of NSAIDs administration can affect the healing of musculoskeletal tissue.…”

“…To our knowledge, most experimental studies to date have focused on the first inflammatory and proliferative phase of healing, in which NSAIDs could have a negative effect in reducing inflammatory cell signaling. This could be a possible explanation for the results of a retrospective study by Mehta et al, 37 which demonstrated increased laxity of ACLRs at 6 weeks postoperatively in patients administered ketorolac. However, NSAIDs could have a more positive effect on healing in the later maturation and remodeling phase because they can contribute to increased protein synthesis.…”

“…5 However, at least 1 clinical study has suggested a deleterious effect of NSAIDs on ACL laxity. 37 Therefore, this study aimed to assess the effect of NSAIDs on the risk of revision and patient-reported quality of life (QOL) in individuals undergoing primary ACLR.…”