Smoking is associated with poorer outcome after rotator cuff repair

Abstract

Introduction: Despite smoking is known to result in higher re-tear rate after rotator cuff repair (RCR), there are still controversies whether smoking affects clinical outcomes. Methods: A prospective case-control study was performed in patients receiving arthroscopic RCR and postoperative MRI to investigate the (1) association between smoking and RCR re-tear; and (2) the impact of smoking on postoperative clinical outcomes. The presence of full thickness re-tear was assessed in postoperative magnetic resonance imaging (MRI) using Sugaya classification. The secondary outcomes were clinical results at final follow-up (VAS, ASES and active forward flexion, FF). Results: One hundred patients, who received arthroscopic supraspinatus repair and postoperative MRI at a duration of 17 months, were recruited. The mean follow-up was 43 months. The 2-year follow-up rate was 96%. There were 26 smokers and 74 non-smokers. In all, 14 full thickness re-tears were identified. The overall RCR re-tear rate was 14%. The incidence of re-tear was higher in smokers (26.9%) than non-smokers (9.5%) with an odd ratio of 3.6 (p=0.027). Significant improvement of VAS, ASES and FF were found in both smoker and non-smoker. Better results were noted in non-smokers, when compared with smokers, in all the clinical outcomes in the remaining 86 patients with intact repair (VAS: 1.4 vs 2.7, p=0.006; ASES: 80.9 vs 62.4, p<0.001, FF: 161 vs 147 degree, p=0.013). Conclusion: The incidence of retear after RCR was significantly lower in non-smokers (9.5%) than smokers (26.9%). Clinical outcomes (VAS, ASES, FF) of patients with intact repair were also better in non-smokers.