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The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair

BACKGROUND: There has been recent interest in the effect of nonsteroidal anti-inflammatory medications on musculoskeletal healing. No studies have yet addressed the effect of these medications on meniscal healing. HYPOTHESIS: The administration of ketorolac in the perioperative period will result in...

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Autores principales: Proffen, Benedikt L., Nielson, Jason H., Zurakowski, David, Micheli, Lyle J., Curtis, Christine, Murray, Martha M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2014
Materias:
121
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228481/
https://www.ncbi.nlm.nih.gov/pubmed/25401118
http://dx.doi.org/10.1177/2325967114529537
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author Proffen, Benedikt L.
Nielson, Jason H.
Zurakowski, David
Micheli, Lyle J.
Curtis, Christine
Murray, Martha M.
author_facet Proffen, Benedikt L.
Nielson, Jason H.
Zurakowski, David
Micheli, Lyle J.
Curtis, Christine
Murray, Martha M.
author_sort Proffen, Benedikt L.
collection PubMed
description BACKGROUND: There has been recent interest in the effect of nonsteroidal anti-inflammatory medications on musculoskeletal healing. No studies have yet addressed the effect of these medications on meniscal healing. HYPOTHESIS: The administration of ketorolac in the perioperative period will result in higher rates of meniscal repair clinical failure. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 110 consecutive patients underwent meniscal repair at our institution between August 1998 and July 2001. Three patients were lost to follow-up, and the remaining 107 (mean age, 15.9 ± 4.4 years) had a minimum 5-year follow-up (mean follow-up, 5.5 years). Thirty-two patients (30%) received ketorolac perioperatively. The primary outcome measure was reoperation for continued symptoms of meniscal pathology. Asymptomatic patients were evaluated by the International Knee Documentation Committee (IKDC) Subjective Knee Form, Short Form–36 (SF-36) Health Survey, and Knee Outcome Osteoarthritis Score (KOOS). RESULTS: Kaplan-Meier survivorship revealed no difference in reoperation rates with and without the administration of perioperative ketorolac (P = .95). There was an overall failure rate of 35% (37/107 patients), with a 34% failure rate in patients receiving ketorolac (11/32 patients). Multivariable Cox regression confirmed that age, duration of symptoms, meniscal tear type, fixation technique, concurrent anterior cruciate ligament repair, and ketorolac usage did not have an impact on the rate of failure (P > .05 for all; ketorolac use, P > .50). Female sex (P = .04) and medial location (P = .01) were predictive of an increased risk for reoperation. CONCLUSION: Failure of meniscal repair was not altered with the administration of perioperative ketorolac. Further work studying the effects of longer term anti-inflammatory use after meniscal repair is necessary before stating that this class of medications has no effect on meniscal healing. CLINICAL RELEVANCE: Results of this study suggest that nonsteroidal anti-inflammatory ketorolac can be administered perioperatively during a meniscal repair procedure to harness its benefits of decreased narcotic requirement, decreased pain, and shorter length of hospital stay without negatively influencing the long-term outcome of the surgery.
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spelling pubmed-42284812014-11-12 The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair Proffen, Benedikt L. Nielson, Jason H. Zurakowski, David Micheli, Lyle J. Curtis, Christine Murray, Martha M. Orthop J Sports Med 121 BACKGROUND: There has been recent interest in the effect of nonsteroidal anti-inflammatory medications on musculoskeletal healing. No studies have yet addressed the effect of these medications on meniscal healing. HYPOTHESIS: The administration of ketorolac in the perioperative period will result in higher rates of meniscal repair clinical failure. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 110 consecutive patients underwent meniscal repair at our institution between August 1998 and July 2001. Three patients were lost to follow-up, and the remaining 107 (mean age, 15.9 ± 4.4 years) had a minimum 5-year follow-up (mean follow-up, 5.5 years). Thirty-two patients (30%) received ketorolac perioperatively. The primary outcome measure was reoperation for continued symptoms of meniscal pathology. Asymptomatic patients were evaluated by the International Knee Documentation Committee (IKDC) Subjective Knee Form, Short Form–36 (SF-36) Health Survey, and Knee Outcome Osteoarthritis Score (KOOS). RESULTS: Kaplan-Meier survivorship revealed no difference in reoperation rates with and without the administration of perioperative ketorolac (P = .95). There was an overall failure rate of 35% (37/107 patients), with a 34% failure rate in patients receiving ketorolac (11/32 patients). Multivariable Cox regression confirmed that age, duration of symptoms, meniscal tear type, fixation technique, concurrent anterior cruciate ligament repair, and ketorolac usage did not have an impact on the rate of failure (P > .05 for all; ketorolac use, P > .50). Female sex (P = .04) and medial location (P = .01) were predictive of an increased risk for reoperation. CONCLUSION: Failure of meniscal repair was not altered with the administration of perioperative ketorolac. Further work studying the effects of longer term anti-inflammatory use after meniscal repair is necessary before stating that this class of medications has no effect on meniscal healing. CLINICAL RELEVANCE: Results of this study suggest that nonsteroidal anti-inflammatory ketorolac can be administered perioperatively during a meniscal repair procedure to harness its benefits of decreased narcotic requirement, decreased pain, and shorter length of hospital stay without negatively influencing the long-term outcome of the surgery. SAGE Publications 2014-05-01 /pmc/articles/PMC4228481/ /pubmed/25401118 http://dx.doi.org/10.1177/2325967114529537 Text en © The Author(s) 2014 http://creativecommons.org/licenses/by-nc-nd/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (http://www.creativecommons.org/licenses/by-nc-nd/3.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access page (http://www.uk.sagepub.com/aboutus/openaccess.htm).
spellingShingle 121
Proffen, Benedikt L.
Nielson, Jason H.
Zurakowski, David
Micheli, Lyle J.
Curtis, Christine
Murray, Martha M.
The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair
title The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair
title_full The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair
title_fullStr The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair
title_full_unstemmed The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair
title_short The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair
title_sort effect of perioperative ketorolac on the clinical failure rate of meniscal repair
topic 121
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228481/
https://www.ncbi.nlm.nih.gov/pubmed/25401118
http://dx.doi.org/10.1177/2325967114529537
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