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INDOMETHACIN AND CELECOXIB IMPAIR ROTATOR CUFF TENDON-TO-BONE HEALING

Professor Martin P Schwellnus, University of Cape Town, South Africa

Background: Non-steroidal anti-inflammatory drugs (non-selective and cyclooxygenase-2-specific) have been shown to impair bone formation, but whether they have a negative effect on tendon-to-bone healing is not known.

Research question/s: Do traditional non-selective non-steroidal anti-inflammatory drugs and cyclooxygenase-2-specific non-steroidal anti-inflammatory drugs negatively affect tendon-to-bone healing.

Methodology:Subjects:180 rats that underwent acute rotator cuff repairs.:Experimental procedure:In the 14 day post-operative period rats were randomly assigned to one of three groups: Control (CON = 60, receiving standard rat chow), Indomethacin (3 mg/kg/day, traditional non-selective anti-inflammatory drug) (IND = 60), or Celecoxib (10 mg/kg/day, cyclooxygenase-2-specific non-steroidal anti-inflammatory drug) (CEL = 60). Animals were sacrificed at 2, 4 and 8 weeks, and tissue was analysed.:Measures of outcome:Tissue analysis by gross inspection, biomechanical testing, histological analysis, collagen formation and maturation (polarised light microscopy).

Main finding/s:


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  • Failure to heal: failure to heal was evident in four tendons in the CEL and one tendon in the IND group.

  • Collagen organisation and maturation: there was significantly less collagen organisation and maturation in the IND and CEL groups compared with CON at 4 and 8 weeks (p<0.001).

Conclusion/s:

  • In an animal study of tendon-bone healing following rotator cuff repair, both a traditional non-selective as well as a cyclooxygenase-2-specific non-steroidal anti-inflammatory drugs inhibited tendon-to-bone healing.

  • The common practice of administering non-steroidal anti-inflammatory drugs following …

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