title: The Effect of Limited Perioperative Nonsteroidal Anti-inflammatory Drugs on Patients Undergoing Anterior Cruciate Ligament Reconstruction.
abstract: 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.
authors: Department of Orthopedic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway endre.soreide@gmail.com.
authors: Endre
authors: E
authors: Soreide
authors: Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.|Oslo Sport Trauma Research Center, Norwegian School of Sport Science, Oslo, Norway.
authors: Lars-Petter
authors: LP
authors: Granan
authors: Department of Orthopedic Surgery, Martina Hansens Hospital, Gjettum, Norway.
authors: Geir A
authors: GA
authors: Hjorthaug
authors: Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
authors: Birgitte
authors: B
authors: Espehaug
authors: Department of Orthopedic Surgery, Lovisenberg Diakonale Hospital, Oslo, Norway.
authors: Sigbjørn
authors: S
authors: Dimmen
authors: Department of Orthopedic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway.
authors: Lars
authors: L
authors: Nordsletten
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007718:Knee Injuries / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D009664:Norway; D020370:Osteoarthritis, Knee / Q000601:surgery; D016016:Proportional Hazards Models; D011788:Quality of Life; D012042:Registries; D012306:Risk; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Knee Injury and Osteoarthritis Outcome Score; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; anterior cruciate ligament reconstruction revision; nonsteroidal anti-inflammatory drug