Timing matters: NSAIDs interfere with the late proliferation stage of a repaired rotator cuff tendon healing in rats

Introduction

Rotator cuff (RC) tear is a common problem that causes pain and can limit shoulder function. Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed for musculoskeletal pain, including the pain subsequent to RC repair. NSAIDs have been reported to affect bone metabolism and fracture healing^, but there is little evidence about their effect on tendon healing. We investigated the effect of meloxicam (non-steroidal anti-inflammatory drug) on the healing of RC tendons when given immediately after surgical repair.

Materials and methods

Thirty-nine rats underwent acute RC tear and repair. Group A (n = 13) received daily intraperitoneal (IP) injections of meloxicam for the first 10 postoperative days. Group B (n = 13) received IP injections of meloxicam starting from postoperative day 11. Group C (n = 13, controls) received daily IP injections of saline for 3 weeks. The animals were killed 3 weeks after surgery and the RC was evaluated by gross inspection, biomechanical testing and histological examination.

Results

Group B displayed a significantly lower mean maximal load at 3 weeks than group C (P = 0.02) and group A (P = 0.05). Stiffness was significantly lower in B group as compared to A group (P = 0.05). Qualitative examination of histology specimens did not disclose any apparent differences with respect to cellularity, vascularity, healing, and collagen orientation.

Conclusions

We conclude that meloxicam decreases the biomechanical strength of repaired rat RCs when administered between 11 and 20 days after the repair.     

Enema-induced perforation of the rectum in chronically constipated patients

INTRODUCTION: The use of retrograde irrigation enemas is common in the treatment of chronic constipation, especially in the elderly. Perforation of the rectum and sigmoid colon caused by cleansing enemas, used by chronically constipated patients, has not been previously described. METHODS: We reviewed all patients with colorectal perforations caused by irrigation enemas admitted to our service in the three-year period between January 1995 and December 1997. RESULTS: Thirteen patients were treated by our surgical service because of perforations of the rectum and sigmoid colon related to a previous retrograde irrigation enema. Ten of these patients came from nursing homes, and the other three lived at home. The relevant information relating the enema administration to the patient's condition was given in only two of the ten patients referred to the emergency room by the institution's nursing or medical staff. In the other eight the information was vague and sometimes misleading. The diagnosis of colorectal performation was made by history, plain abdominal x-rays, and CT scan with or without meglumine diatrizoate enemas. Ten patients survived, regardless of age, previous diseases, or operative findings. In all of them, diagnosis was made within 36 hours from the perforation. The three deaths occurred in patients in whom the diagnosis was made late. CONCLUSIONS: Awareness of the possible injury from enemas administered to chronically constipated patients should be stressed. A high degree of suspicion by the attending physician is extremely important, because prompt diagnosis and early surgical treatment carries a relatively good prognosis.