title: The detrimental effects of systemic Ibuprofen delivery on tendon healing are time-dependent.
abstract: BACKGROUND
  Current clinical treatment after tendon repairs often includes prescribing NSAIDs to limit pain and inflammation. The negative influence of NSAIDs on bone repair is well documented, but their effects on tendon healing are less clear. While NSAIDs may be detrimental to early tendon healing, some evidence suggests that they may improve healing if administered later in the repair process.
  
  
  OBJECTIVE
  We asked whether the biomechanical and histologic effects of systemic ibuprofen administration on tendon healing are influenced by either immediate or delayed drug administration.
  
  
  METHODS
  After bilateral supraspinatus detachment and repair surgeries, rats were divided into groups and given ibuprofen orally for either Days 0 to 7 (early) or Days 8 to 14 (delayed) after surgery; a control group did not receive ibuprofen. Healing was evaluated at 1, 2, and 4 weeks postsurgery through biomechanical testing and histologic assessment.
  
  
  RESULTS
  Biomechanical evaluation resulted in decreased stiffness and modulus at 4 weeks postsurgery for early ibuprofen delivery (mean ± SD [95% CI]: 10.8 ± 6.4 N/mm [6.7-14.8] and 8.9 ± 5.9 MPa [5.4-12.3]) when compared to control repair (20.4 ± 8.6 N/mm [16.3-24.5] and 15.7 ± 7.5 MPa [12.3-19.2]) (p = 0.003 and 0.013); however, there were no differences between the delayed ibuprofen group (18.1 ± 7.4 N/mm [14.2-22.1] and 11.5 ± 5.6 MPa [8.2-14.9]) and the control group. Histology confirmed mechanical results with reduced fiber reorganization over time in the early ibuprofen group.
  
  
  CONCLUSIONS
  Early administration of ibuprofen in the postoperative period was detrimental to tendon healing, while delayed administration did not affect tendon healing.
  
  
  CONCLUSIONS
  Historically, clinicians have often prescribed ibuprofen after tendon repair, but this study suggests that the timing of ibuprofen administration is critical to adequate tendon healing. This research necessitates future clinical studies investigating the use of ibuprofen for pain control after rotator cuff repair and other tendon injuries.
authors: McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 34th and Hamilton Walk, Philadelphia, PA, 19104, USA.
authors: Brianne K
authors: BK
authors: Connizzo
authors: Sarah M
authors: SM
authors: Yannascoli
authors: Jennica J
authors: JJ
authors: Tucker
authors: Adam C
authors: AC
authors: Caro
authors: Corinne N
authors: CN
authors: Riggin
authors: Robert L
authors: RL
authors: Mauck
authors: Louis J
authors: LJ
authors: Soslowsky
authors: David R
authors: DR
authors: Steinberg
authors: Joseph
authors: J
authors: Bernstein
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000633:toxicity*; D001696:Biomechanical Phenomena; D004195:Disease Models, Animal; D004334:Drug Administration Schedule; D055119:Elastic Modulus; D007052:Ibuprofen / Q000008:administration & dosage* / Q000633:toxicity*; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D013708:Tendon Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013710:Tendons / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D058971:Tenotomy; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen
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