Anti-inflammatory use and rotator cuff repair outcomes: a prospective 5-year cohort follow-up of 2,533 patients

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are a mainstay of postoperative pain control following rotator cuff repair, despite a thorough understanding of their effects on clinical outcomes. This paper aims to assess the influence of NSAID use on pain and functional outcomes for 5 years postoperatively. Methods: Patients undergoing rotator cuff repair throughout New Zealand were enrolled in this prospective cohort study from March 1, 2009, to December 31, 2010, with 2,533 primary repairs included. Follow-up was 81% at 5 years. Demographic, preoperative, and intraoperative data as well as NSAID use duration were recorded, with follow-up at 6, 12, 24 months, and 5 years, measuring Flex Shoulder Function and visual analog scale pain score. Results: In total, 72% of the study population used NSAIDs postoperatively; 18% took NSAIDs for up to 2 weeks in duration, 21% 3-6 weeks, 12% 7 weeks to 3 months and 21% over 3 months. NSAID use for longer than 2 weeks was associated with poorer function at 6 and 12 months postoperatively, with use longer than 6 weeks associated with poorer function at 6, 12, 24 months, and 5 years. Improvement in function was significantly lower in those taking NSAIDs for more than 3 months (P=0.04). A higher rate of stiffness was seen in the NSAID group (P<0.001). Conclusion: Use of NSAIDs longer than 6 weeks following rotator cuff repair was associated with poorer functional outcomes, and higher pain with extended use. This data raises concern regarding potential detrimental effects of NSAIDs following rotator cuff repair, and further research is required to determine their safe duration of use. Level of evidence: II.