O1384 NSAIDS AND VASCULAR PROLIFERATION IN THE TORN ROTATOR CUFF

Abstract

Background: Microvessels have been identified in the functionally avascular critical zone of the rotator cuff. Inadequate local sprouting of these capillaries might impair attempts at repair. We have identified widespread VEGF positivity in endothelial cells. However, this was accompanied by strong positivity for the cell cycle inhibitor p27 and little proliferation (Ki-67 positivity). Non-steroidal anti-inflammatory drugs (NSAID) can impair healing by inhibiting angiogenesis. The mechanisms include upregulation of p27 in endothelial cells. Objective: Does NSAIDs influence endothelial cell proliferation in torn rotator cuff? Methods: Pathological assessment of Rotator cuff tissue, obtained from 35 patients undergoing surgical repair, was performed on H& E sections. Ongoing vascular proliferation was identified by plump endothelial cells and budding of vessels. Preoperative drug prescription data was obtained from patient’s General practitioners. The drugs used were NSAIDs (including Ibuprofen and Diclofenac), COX2 inhibitors & Opiates. Results: Ongoing vascular proliferation was not identified in 20/35 patients. 25 patients were taking analgesics; vascular proliferation was absent in 15. 20 patients were taking NSAIDs of these 15 demonstrated no ongoing vascular proliferation, (p≤0.014). No significant effect of opiates or COX2inhibitors was found. Discussion: Patients taking NSAIDs showed a significant reduction in vascular proliferation. If endothelial cell proliferation is an important component of repair in rotator cuff tears, more work should be done to clarify this matter.