The Adverse Effect of COX-2 Selective Inhibitor on Ligament Healing

By: Rudy Dewantara MD

The widespread use of NSAIDs is a commonplace in acute sports injury in order to diminish pain and swelling particularly in acute phase. In general there are two groups of NSAIDs, non spesific (inhibit both COX-1 and COX-2 enzymes) and COX-2 selective inhibitor. Some studies have been performed on COX-2 selective inhibitor, celecoxib, to determine its effect on ligament injury.
In 2001, Christopher L. Elder et al used the surgically incised medial collateral ligament of male Sprague-Dawley rats as an experimental model for acute ligament injuries to investigate the effects of celecoxib on ligament healing. Fifty rats underwent surgical transection of the right medial collateral ligament. Postoperatively, half were given celecoxib for the first 6 days of recovery, the other half were not. The animals were sacrificed 14 days after the operation, and both the injured and uninjured medial collateral ligaments were mechanically tested to failure in tension. Celecoxib-treated/injured ligaments were found to have a 32% lower load to failure than untreated/injured ligaments. The results of this study is do not support use of cyclooxygenase-2 specific inhibitors in the treatment of ligament injuries.
Stuart J. Warden et al studied the use of celecoxib and low-intensity pulsed ultrasound, either used alone or combined. The result is low-intensity pulsed ultrasound accelerated but did not improve ligament healing, whereas celecoxib delayed but did not impair healing. When used in combination, the beneficial low-intensity pulsed ultrasound effect was cancelled by the detrimental celecoxib effect.
Some other similar studies on celecoxib showed the same results. Since acute soft injury involving ligament is one of the most frequent injury especially in atheletes, it is best to avoid the use of COX-2 selective inhibitor .

Regards,
RUdy Dewantara MD

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