Soreide Endre, Granan Lars-Petter, Hjorthaug Geir A, Espehaug Birgitte, Dimmen Sigbjørn, Nordsletten Lars
Department of Orthopedic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway
Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
Am J Sports Med. 2016 Dec;44(12):3111-3118. doi: 10.1177/0363546516657539. Epub 2016 Aug 5.
The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) to patients undergoing anterior cruciate ligament reconstruction (ACLR) is controversial because it may impair tissue healing and clinical outcomes.
To assess the effect of NSAID administration on patients undergoing ACLR.
Cohort study; Level of evidence, 3.
Included patients were aged >15 years and were registered in the Norwegian Knee Ligament Registry from 2008 until 2013 after the primary ACLR. Patients with insufficient data regarding administration of NSAIDs and those with associated knee ligament injuries requiring surgical treatment were excluded from this study. Graft survival was estimated using Kaplan-Meier survival curves, and hazard ratios (HRs) for revision were evaluated using Cox regression analysis. Logistic regression analysis was used to calculate the odds ratio (OR) for a Knee Injury and Osteoarthritis Outcome Score (KOOS)-quality of life (QOL) subscale score <44 at 2-year follow-up.
A total of 7822 patients were included in the analysis for graft survival and assessment for risk of revision. Of these, 4144 patients were administered NSAIDs postoperatively. The mean duration of follow-up was 2.8 years (range, 0-5.9 years). Administration of NSAIDs did not influence graft survival (P = .568). Adjusted Cox regression analyses demonstrated the same finding regarding risk of revision (HR, 1.0; 95% CI, 0.8-1.3). ACLR using a bone-patellar tendon-bone autograft showed a reduced risk of revision (HR, 0.3; 95% CI, 0.1-0.8) among patients administered NSAIDs. In subgroup analyses of 3144 patients, administration of NSAIDs demonstrated a beneficial effect on the risk of a KOOS-QOL score <44 at 2-year follow-up (OR, 0.8; 95% CI, 0.6-0.9).
Administration of NSAIDs to patients after ACLR does not have a negative effect on graft survival, risk of revision, or risk of a KOOS-QOL score <44 at 2-year follow-up. We emphasize using caution when administering NSAIDs by keeping the duration and dosage of NSAIDs as short and low as possible to ensure sufficient pain relief while limiting unwanted exposure to any known and unknown adverse effects of these drugs.
对前交叉韧带重建（ACLR）患者使用非甾体类抗炎药（NSAIDs）存在争议，因为这可能会损害组织愈合和临床疗效。
评估NSAIDs给药对ACLR患者的影响。
队列研究；证据等级，3级。
纳入的患者年龄>15岁，于2008年至2013年在初次ACLR后登记于挪威膝关节韧带登记处。本研究排除了NSAIDs给药数据不足的患者以及伴有需要手术治疗的膝关节韧带损伤的患者。使用Kaplan-Meier生存曲线估计移植物存活率，并使用Cox回归分析评估翻修的风险比（HRs）。采用逻辑回归分析计算2年随访时膝关节损伤和骨关节炎疗效评分（KOOS）-生活质量（QOL）子量表评分<44的比值比（OR）。
共有7822例患者纳入移植物存活率分析和翻修风险评估。其中，4144例患者术后使用了NSAIDs。平均随访时间为2.8年（范围0 - 5.9年）。NSAIDs给药不影响移植物存活率（P = 0.568）。校正后的Cox回归分析在翻修风险方面显示了相同的结果（HR，1.0；95%CI，0.8 - 1.3）。在使用NSAIDs的患者中，采用骨-髌腱-骨自体移植物进行ACLR显示翻修风险降低（HR，0.3；95%CI，0.1 - 0.8）。在对3144例患者的亚组分析中，NSAIDs给药在2年随访时对KOOS-QOL评分<44的风险显示出有益影响（OR，0.8；95%CI，0.6 - 0.9）。
ACLR术后对患者使用NSAIDs对移植物存活率、翻修风险或2年随访时KOOS-QOL评分<44的风险没有负面影响。我们强调在使用NSAIDs时要谨慎，尽量缩短NSAIDs的使用时间并降低剂量，以确保充分缓解疼痛，同时限制这些药物已知和未知的不良影响的不必要暴露。
