Jeffrey S. Abrams, MD

Guillem Gonzalez-Lomas, MD, and colleagues have presented on whether NSAIDs will affect the healing of a Bankart shoulder repair. Anatomic repair for anterior shoulder dislocation is a common treatment often performed arthroscopically and, in select cases, as an open procedure. Pain management has gained attention as the opioid crisis has introduced other forms of analgesia, including the use of nonsteroidal anti-inflammatory medications as a substitute for oxycontin or similar medications. There have been some studies of delayed or incomplete healing with early postoperative use of NSAID treatment when performing rotator cuff surgery. Gonzales-Lomas has studied an instability recurrence in patients using NSAIDs in conjunction of oxycontin or oxycontin without NSAIDs. Their findings did not suggest a significantly different outcome when NSAIDs were used to assist early pain management.

Although I am encouraged by this presentation at AAOS, I remain concerned with their conclusions. Although numerical significance was not determined, this may be due to small sample size and short follow-up. The criticism of a soft tissue repair has been that this is a short period of study following return to activities and continued sports participation would increase failure rates with additional time.

As in other postoperative healing surgeries, early use of NSAIDs may produce a small effect on healing potential, but in this active population, reduced recurrence is at a premium. The reduction of opioid use is an important message promoted by this study. Techniques that reduce medication needs, as in icing, selective compression, massage and therapeutic modalities, should be considered as important postoperative details. The jury may still be out on the use of NSAIDs during the early postoperative period following shoulder stabilization surgery.