Hadro Adam, Huyke-Hernandez Fernando A, Kleinsmith Rebekah M, Doxey Stephen A, Schweitzer Adam, Ristow Jacob, Cunningham Brian P, Braman Jonathan
Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA.
Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA.
J Orthop. 2024 May 16;56:119-122. doi: 10.1016/j.jor.2024.05.019. eCollection 2024 Oct.
The impact of non-steroidal anti-inflammatory drugs (NSAIDs) on rotator cuff repair is an ongoing area of study within orthopedics, with conflicting results in current literature. Despite concerns over the deleterious effects of NSAIDs on rotator cuff healing, they are becoming an integral part of a multimodal post-operative pain control regiment. The purpose of this study was to compare post-operative patient-reported outcomes (PROs), complications rates, and retear rates of arthroscopic rotator cuff repairs in patients using ibuprofen post-operatively to those who abstained from NSAIDs for six weeks after surgery. It was hypothesized that a short course of ibuprofen post-operatively would not lead to inferior PRO scores, increased retear rates, nor increased complication rates after arthroscopic rotator cuff repair.
Patients of the primary surgeon who underwent arthroscopic rotator cuff repair between 2012 and 2022 were evaluated by retrospective chart review. In May 2017 the primary surgeon changed his protocol from avoiding NSAIDs for six weeks after surgery to routinely prescribing two weeks of Ibuprofen 800 mg TID post-operatively. Patients who avoided NSAIDs for six weeks were compared to patients who were prescribed NSAIDs post-operatively. Patient demographic data, pre-operative MRI results, pre-operative and post-operative PROs were collected from the EMR. Additionally, post-operative complications and repair failures requiring reoperation within one year were evaluated.
125 patients met inclusion criteria for this study with 36 patients in the NSAID group and 89 in the no NSAID group. When comparing improvement in PROs, the NSAID group reached MCID at one year in 83.8 % of patients and the no NSAID group reached MCID at one year in 73.9 % of patients. There was no significant difference between the groups in reaching MCID improvement at one year (p = 0.471). Five post-operative complications were reported in the no NSAID group and two in the NSAID group (5.7 % vs 5.4 %, respectively, p = 0.827). Finally, there was no significant difference in the percentage of post-operative rotator cuff repair failures requiring revision in the first year between the groups (2.3 % vs 2.7 %, p = 1.000).
There was no difference in percent of patients improving their PRO by the MCID between the groups that used ibuprofen and the group that did not. There was also no difference in post-operative complication rates and rates of symptomatic retear requiring reoperation between the groups. This supports that a short course of NSAIDs post-operatively, specifically ibuprofen, after rotator cuff repair does not increase reoperation rates nor lead to a clinically significant decrease in PROs at one year.
非甾体抗炎药（NSAIDs）对肩袖修复的影响是骨科领域一个仍在研究的课题，目前的文献结果相互矛盾。尽管人们担心NSAIDs对肩袖愈合有有害影响，但它们正成为多模式术后疼痛控制方案的一个组成部分。本研究的目的是比较术后使用布洛芬的患者与术后六周不使用NSAIDs的患者在关节镜下肩袖修复术后患者报告的结果（PROs）、并发症发生率和再撕裂率。研究假设是，术后短期使用布洛芬不会导致PRO评分降低、再撕裂率增加或关节镜下肩袖修复术后并发症发生率增加。
通过回顾性病历审查对2012年至2022年间接受关节镜下肩袖修复的主刀医生的患者进行评估。2017年5月，主刀医生将其方案从术后六周避免使用NSAIDs改为常规术后开两周800毫克布洛芬，每日三次。将术后六周避免使用NSAIDs的患者与术后使用NSAIDs的患者进行比较。从电子病历中收集患者人口统计学数据、术前MRI结果、术前和术后PROs。此外，评估术后并发症以及一年内需要再次手术的修复失败情况。
125名患者符合本研究的纳入标准，其中NSAID组36名患者，非NSAID组89名患者。在比较PROs的改善情况时，NSAID组83.8%的患者在一年时达到最小临床重要差异（MCID），非NSAID组73.9%的患者在一年时达到MCID。两组在一年时达到MCID改善情况方面无显著差异（p = 0.471）。非NSAID组报告了5例术后并发症，NSAID组报告了2例（分别为5.7%和5.4%，p = 0.827）。最后，两组之间第一年需要翻修的术后肩袖修复失败百分比无显著差异（2.3%对2.7%，p = 1.000）。
使用布洛芬的组与未使用布洛芬的组在通过MCID改善PRO的患者百分比方面没有差异。两组在术后并发症发生率以及需要再次手术的有症状再撕裂率方面也没有差异。这支持了肩袖修复术后短期使用NSAIDs，特别是布洛芬，不会增加再次手术率，也不会导致一年时PROs出现临床上的显著下降。
