Vascular proliferation and non steroidal anti-inflammatory drugs in the torn rotator cuff

Purpose: To determine whether administration of non-steroidal anti-inflammatory drugs (NSAID) influences ongoing endothelial cell proliferation in torn rotator cuff? Methods: Rotator cuff tissue, obtained at debridement from 53 patients undergoing surgical repair, was fixed and embedded. Pathological assessment was performed on H&E sections. Ongoing vascular proliferation was identified by plump endothelial cells and budding of vessels. Patient cuff details and preoperative drug prescription data was obtained from patient’s notes and general practitioners. The drugs considered were NSAIDs (including Aspirin, Ibuprofen and Diclofenac), COX 2 inhibitors & Opiates. Results: Of the 35 patients taking analgesics, vascular proliferation was absent or reduced in 22 (63%). 20 of these patients were taking NSAIDs. Four patients were taking only COX-2 inhibitors, all these patients had increased vascularity. 23 patients were taking codeine based analgesics, of 10 patients using codeine without NSAIDs, 8 demonstrated active ongoing vascular proliferation (p=0.027). Conclusion: Patients taking NSAIDs showed a significant reduction in ongoing vascular proliferation. If endothelial cell proliferation is an important component of repair processes in rotator cuff, this could be compromised. NSAIDs can impair healing by inhibiting angiogenesis, the mechanism includes upregulation of p27 in endothelial cells. We have peviously identified strong p27 positivity in rotator cuff endothelial cells.