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Vascular Proliferation and NSAIDS in the Torn Rotator Cuff

Authors: Simon Frostick

References: AAOS 2005

Abstract
Patients taking NSAIDs showed a significant reduction in ongoing vascular proliferation in rotator cuff which may impair healing in torn rotator cuff.

Non-steroidal anti-inflammatory drug (NSAID) administration is very common in patients with rotator cuff tears. Repeat prescription NSAID administration reduces angiogenesis, impairing healing in gastric ulcers and may impact on endothelial cell proliferation in rotator cuff tissue.

Rotator cuff tissue, obtained at debridement from 53 patients undergoing surgical repair, was fixed and embedded. Pathological assessment was performed on H&E sections. PatientsÂ’ age range was 41-87 years (mean 63.6 years), 30F:23M; duration of symptoms ranged from 3 months to 18 years and the size of the cuff tear ranged from 1-5 cm. Ongoing vascular proliferation was identified by plump endothelial cells and budding of vessels. Patient cuff details and preoperative drug prescription data was obtained from patientÂ’s notes and general practitioners. The drugs considered were NSAIDs (including Aspirin, Ibuprofen and Diclofenac), COX 2 inhibitors & Opiates

Of the 35 patients taking analgesics, vascular proliferation was absent or reduced in 22. 20 of these patients were taking NSAIDs. Four patients were taking only COX-2 inhibitors all these patients had increased vascularity. 23 patients were taking codeine based analgesics, of 10 patients using codeine without NSAIDs, 8 demonstrated active ongoing vascular proliferation (p=0.027).

Patients taking NSAIDs showed a significant reduction in ongoing vascular proliferation. Endothelial cell proliferation is an important component of repair processes in the onset and post-operative stages of rotator cuff problems. Thus healing and repair could be compromised by NSAID administration.

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