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VASCULAR PROLIFERATION AND NSAIDS IN THE TORN ROTATOR CUFF

Authors: A. Rawal, A. Sheth, M.M. Roebuck, S. Kalogrianitis, V. Rayner, and S.P. Frostick

References: J Bone Joint Surg Br Orthopaedic Proceedings, 2005 87-B: 333

Abstract
Introduction and Aims: To determine whether non-steroidal anti-inflammatory drugs (NSAID) administration influences ongoing endothelial cell proliferation in tom rotator cuff?

Method: Rotator cuff tissue, obtained at debridement from 53 patients undergoing surgical repair, was fixed and embedded. Pathological assessment was performed on H&E sections. Ongoing vascular proliferation was identified by plump endothelial cells and budding of vessels. Patient cuff details and pre-operative drug prescription data was obtained from patients’ notes and by telephone from general practitioners. The drugs used were NSAIDs (including Aspirin, Ibuprofen and Diclofenac), COX 2 inhibitors and Opiates. The data was analysed using the SPSS program and the Pearson Chi-square test.

Results: Of the 35 patients taking analgesics, vascular proliferation was absent or reduced in 22 (63%). Twenty of these patients were taking NSAIDs. Four patients were taking only COX-2 inhibitor drugs; all these patients had increased vascularity. Twenty-three patients were taking codeine-based analgesics. Of 10 patients using codeine without NSAIDs, eight demonstrated active ongoing vascular proliferation (p=0.027).

Conclusion: Patients taking NSAIDs showed a significant reduction in ongoing vascular proliferation. If endothelial cell proliferation is an important component of repair in either the onset or post-operative stages of rotator cuff pathology, then attempts at repair could be compromised by inadequate local function of the vascular system. We have previously identified strong p27 positivity in rotator cuff endothelial 0 cells. NSAIDs can impair healing by inhibiting angiogenesis; the mechanism includes upregulation of p27 in endothelial cells. More work should be done to clarify this matter in the rotator cuff.

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