Effects of Nonsteroidal Anti-Inflammatory Drugs on Flexor Tendon Adhesion

Virak Tan, Ali Nourbakhsh, John Capo, Jessica A. Cottrell, Marcus Meyenhofer, J. Patrick O'Connor

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Purpose: Besides its anti-inflammatory effects, nonsteroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The purpose of this study was to compare the effect of nonselective (ibuprofen) and COX-2 selective (rofecoxib) nonsteroidal anti-inflammatory drugs on the adhesion formation after tendon repair. Methods: We assigned 67 rabbits to one of 3 (placebo, ibuprofen, or rofecoxib) groups. The deep flexor tendon was transected, followed by a primary repair. Dosing of the medication began the day after surgery and continued for 27 days. The animals were immobilized in a cast for the first 14 days. Postoperatively, tendon adhesion formation was assessed histologically by calculating the total adhesion in serial axial tendon sections at 3 and 6 weeks and by range of motion measurements at 6 and 12 weeks. We measured range of motion by fixing the metacarpal, applying increasing weight to the free end of the flexor digitorum profundus, and measuring the flexion angle between the metacarpal and the proximal phalanx. Comparison was performed between the treatment groups, as well as to the unoperated forepaws. Results: Based on histology, we found no difference between the treatment groups when determining the percentage of adhesion between the flexor tendon and its sheath. Control unoperated forepaws had a significantly greater range of metacarpophalangeal joint flexion than the surgically repaired groups. At 12 weeks, range of motion in the ibuprofen group was significantly better than the placebo (p=.009) and rofecoxib (p=.009) groups. Conclusions: Ibuprofen has a more important effect in limiting adhesion formation compared with rofecoxib after flexor tendon repair. Because ibuprofen inhibits both COX-1 and COX-2, whereas rofecoxib only inhibits COX-2, ibuprofen therapy appears to offer a greater beneficial effect on tendon repair by reducing formation of adhesions.

Original languageEnglish (US)
Pages (from-to)941-947
Number of pages7
JournalJournal of Hand Surgery
Issue number6
StatePublished - Jun 2010

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine


  • COX-2
  • Flexor tendon
  • NSAIDs
  • adhesions
  • rabbit


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