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COX-2 Inhibitors Impair Soft Tissue Healing While Nonselective NSAIDs May Not
Full Title
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Their Effect on Musculoskeletal Soft-Tissue Healing: A Scoping Review.
Summary
This scoping review examined 44 studies to evaluate the effects of NSAIDs on the healing of musculoskeletal soft tissues including ligaments, tendons, labrum, and meniscus. The findings reveal an important distinction between types of NSAIDs. The majority of studies, including 1 of 2 human studies, 10 of 14 animal studies, and 3 of 3 in vitro studies, demonstrated that COX-2-selective inhibitors (such as celecoxib) had a negative impact on soft tissue healing. In contrast, the majority of studies showed that nonselective COX inhibitors (such as ibuprofen) had no negative effect on the healing of labrum, tendons, and ligaments. In vitro studies showed that NSAIDs generally have a harmful effect on the biological processes involved in tendon healing, including tenocyte proliferation and collagen synthesis. This study supports the nuanced position that not all NSAIDs affect healing equally. The anti-inflammatory properties of nonselective NSAIDs may benefit conditions involving tendons, ligaments, and cartilage where inflammation increases reinjury risk, while COX-2 selective inhibitors should be avoided during healing. These findings highlight the importance of understanding which specific medication a patient is taking and how it may interact with their recovery from a soft tissue injury.