American Journal of Sports Medicine
July, 2006

By Anthony J. Brown, MD

Treatment with low-intensity pulsed ultrasound can hasten the healing of torn ligaments in the knee, while the use of NSAID drugs, such as Celebrex (celecoxib) and Motrin (ibuprofen), has the opposite effect, findings from an animal study suggest.

Ligaments are strong fibrous bands that connect bones and help control their range of motion. They are closely related to tendons, which connect muscles to bone.

Low-intensity pulsed ultrasound and NSAIDs have both been used to treat ligament injuries, but their effects on the healing process, when used alone or together, have not been determined.

To investigate, Dr. Stuart J. Warden, from Indiana University in Indianapolis, and colleagues assessed healing in 60 adult rats with experimentally induced injuries to ligaments in both knees. The animals were treated with Celebrex in a carrier solution or with the carrier alone. In each animal, one knee was treated with active ultrasound, while the other received ultrasound without the equipment actually being on.

The researchers' findings appear in The American Journal of Sports Medicine.

Active ultrasound "accelerated ligament healing," Warden told Reuters Health, while "celecoxib did the opposite. Knees treated with these modalities reached the same level of healing, it just took longer when celecoxib was given."

When both Celebrex and active ultrasound were given, the effects canceled each other out. The end result was that these knees healed about as fast as those exposed to inactive ultrasound and vehicle solution.

As to how NSAIDs impair ligament healing, Warden said that it is thought to relate to a reduction in the formation of collagen, the protein responsible for the strength of ligaments.

"NSAIDs are fine if you just use them to control inflammation and pain for 3 or 4 days after injury," Warden noted. "But our findings suggest that you should get off of them as soon as you can because they can impair ligament healing."

For people still experiencing pain beyond 3 or 4 days, Warden recommended the use of acetaminophen (e.g., Tylenol), known as paracetamol in many countries.