Novikov David A, Swensen Stephanie J, Buza John A, Gidumal Ramesh H, Strauss Eric J
a School of Medicine , Stony Brook University Health Sciences Center , Stony Brook , NY , USA.
b NYU Langone Medical Center , Hospital for Joint Diseases , New York , NY , USA.
Phys Sportsmed. 2016 Nov;44(4):335-341. doi: 10.1080/00913847.2016.1216239. Epub 2016 Aug 11.
Anterior cruciate ligament reconstruction (ACLR) depends on proper healing of the graft or bone plug at the cellular level. The effect of cigarette smoke on ACLR was not commonly reported until recently. The primary purpose of this review was to determine if smoking has a negative effect on subjective or objective outcome scores after ACLR. The secondary purpose was to identify any increased risk of complications, infection, ACL re-tear, or revision procedures.
A systematic literature review of the MEDLINE, SCOPUS and PubMed databases was performed to identify all studies that compared outcomes of ACLR surgery between smokers and nonsmokers. The frequency-weighted mean was calculated for outcome measures that were similar across several studies.
Seventeen studies were identified that met inclusion criteria for patients undergoing ACLR (mean age, 26.8 years) with a mean follow-up of 37 months. Smokers had significantly worse subjective outcome measures and worse side-to-side difference in anterior translation compared to non-smokers (2.68 mm vs 1.89 mm, respectively). In 2 studies, smokers were found to have a significantly higher risk of developing an infection and VTE (venous thromboembolism) post-operatively. The evidence for the effect of smoking on risk for subsequent re-tear is mixed. No study reported a higher rate of development of radiographic knee osteoarthritis among smokers compared to nonsmokers.
Cigarette smoke is associated with significantly worse clinical outcome scores, an increase in anterior translation, and increased complication rates after ACL reconstruction. These findings may help orthopaedic surgeons better inform their patients about the potential negative effects of smoking on the outcomes of ACL reconstruction.
Therapeutic Level IV.
前交叉韧带重建术（ACLR）依赖于移植物或骨栓在细胞水平的正常愈合。直到最近，香烟烟雾对ACLR的影响才被普遍报道。本综述的主要目的是确定吸烟是否会对ACLR术后的主观或客观结果评分产生负面影响。次要目的是确定并发症、感染、前交叉韧带再次撕裂或翻修手术的风险是否增加。
对MEDLINE、SCOPUS和PubMed数据库进行系统的文献综述，以确定所有比较吸烟者和非吸烟者ACLR手术结果的研究。对多项研究中相似的结果指标计算频率加权平均值。
共确定了17项符合ACLR患者纳入标准的研究（平均年龄26.8岁），平均随访37个月。与非吸烟者相比，吸烟者的主观结果指标明显更差，前向平移的双侧差异也更大（分别为2.68毫米和1.89毫米）。在2项研究中，发现吸烟者术后发生感染和静脉血栓栓塞（VTE）的风险明显更高。吸烟对后续再次撕裂风险影响的证据不一。没有研究报告吸烟者与非吸烟者相比，影像学膝关节骨关节炎的发生率更高。
香烟烟雾与ACLR术后明显更差的临床结果评分、前向平移增加和并发症发生率增加有关。这些发现可能有助于骨科医生更好地告知患者吸烟对ACLR结果的潜在负面影响。
治疗性四级。
