The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair.

BACKGROUND

There has been recent interest in the effect of nonsteroidal anti-inflammatory medications on musculoskeletal healing. No studies have yet addressed the effect of these medications on meniscal healing.

HYPOTHESIS

The administration of ketorolac in the perioperative period will result in higher rates of meniscal repair clinical failure.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A total of 110 consecutive patients underwent meniscal repair at our institution between August 1998 and July 2001. Three patients were lost to follow-up, and the remaining 107 (mean age, 15.9 ± 4.4 years) had a minimum 5-year follow-up (mean follow-up, 5.5 years). Thirty-two patients (30%) received ketorolac perioperatively. The primary outcome measure was reoperation for continued symptoms of meniscal pathology. Asymptomatic patients were evaluated by the International Knee Documentation Committee (IKDC) Subjective Knee Form, Short Form-36 (SF-36) Health Survey, and Knee Outcome Osteoarthritis Score (KOOS).

RESULTS

Kaplan-Meier survivorship revealed no difference in reoperation rates with and without the administration of perioperative ketorolac ( = .95). There was an overall failure rate of 35% (37/107 patients), with a 34% failure rate in patients receiving ketorolac (11/32 patients). Multivariable Cox regression confirmed that age, duration of symptoms, meniscal tear type, fixation technique, concurrent anterior cruciate ligament repair, and ketorolac usage did not have an impact on the rate of failure ( > .05 for all; ketorolac use, > .50). Female sex ( = .04) and medial location ( = .01) were predictive of an increased risk for reoperation.

CONCLUSION

Failure of meniscal repair was not altered with the administration of perioperative ketorolac. Further work studying the effects of longer term anti-inflammatory use after meniscal repair is necessary before stating that this class of medications has no effect on meniscal healing.

CLINICAL RELEVANCE

Results of this study suggest that nonsteroidal anti-inflammatory ketorolac can be administered perioperatively during a meniscal repair procedure to harness its benefits of decreased narcotic requirement, decreased pain, and shorter length of hospital stay without negatively influencing the long-term outcome of the surgery.