Level 1 RCT comparing celecoxib, ibuprofen, and tramadol for pain control after arthroscopic rotator cuff repair in 180 patients. It asks whether a selective COX-2 inhibitor is a safe analgesic choice or whether it compromises tendon-to-bone healing. Healing was assessed retrospectively by MRI and ultrasound at 24 months.
The pain scores are a trap here. Celecoxib, ibuprofen, and tramadol all controlled post-op pain equally, so if you judge an analgesic only by comfort you would happily prescribe celecoxib. The healing data flips that decision. A 37% retear rate versus 7% and 4% is a fivefold difference in the outcome that actually matters after a repair.
The mechanism worth remembering: the COX-2/PGE-2 pathway drives the early inflammatory phase that tenocytes and osteoblasts need to rebuild the enthesis. Selectively blocking COX-2 shuts down exactly that phase, which parallels celecoxib's known inhibition of fracture healing.
Apply the same caution you already use with NSAIDs and fracture healing to the tendon-to-bone interface after cuff repair. Treat this as a preliminary signal (retrospective healing arm, high loss to follow-up), not a closed question, but let it push you toward opioids or non-COX analgesics in the early healing window.
Level 1 RCT comparing celecoxib, ibuprofen, and tramadol for pain control after arthroscopic rotator cuff repair in 180 patients. It asks whether a selective COX-2 inhibitor is a safe analgesic choice or whether it compromises tendon-to-bone healing. Healing was assessed retrospectively by MRI and ultrasound at 24 months.
The pain scores are a trap here. Celecoxib, ibuprofen, and tramadol all controlled post-op pain equally, so if you judge an analgesic only by comfort you would happily prescribe celecoxib. The healing data flips that decision. A 37% retear rate versus 7% and 4% is a fivefold difference in the outcome that actually matters after a repair.
The mechanism worth remembering: the COX-2/PGE-2 pathway drives the early inflammatory phase that tenocytes and osteoblasts need to rebuild the enthesis. Selectively blocking COX-2 shuts down exactly that phase, which parallels celecoxib's known inhibition of fracture healing.
Apply the same caution you already use with NSAIDs and fracture healing to the tendon-to-bone interface after cuff repair. Treat this as a preliminary signal (retrospective healing arm, high loss to follow-up), not a closed question, but let it push you toward opioids or non-COX analgesics in the early healing window.