Abstract
Purpose
The effect of smoking on preoperative and postoperative outcome scores as well as quality of life measurements after arthroscopic rotator cuff repair (ARCR) has not been fully understood, and studies regarding this are lacking in the literature. This study aimed to evaluate the effect of smoking on function and quality of life after ARCR.
Methods
Two-hundred patients who underwent full-thickness ARCR with a minimum 1-year follow-up period were included and evaluated retrospectively. The patients were divided into two groups: smokers (Group 1, 59 patients) and nonsmokers (Group 2, 141 patients). Pre- and postoperative Constant Murley (CM) scores, American Shoulder and Elbow Surgeons (ASES) scores, visual analogue scale scores (VASs), and Short-Form 36 health survey (SF-36) scores were used to evaluate functional and quality of life outcomes. The correlation between the smoking amount (pack-years) and outcomes was evaluated.
Results
A total of 200 patients included into study (90 male and 110 female) with mean age of 62.68 ± 3.98. There was no statistically significant difference between the two groups regarding preoperative scores, except in the ASES score (P = 0.021\()\) Additionally, there was a statistically significant difference between the groups regarding postoperative CM score, ASES score, and VAS, and in physical functioning and role limitations due to physical health domains of the SF-36 (P = 0.029, P = 0.038, P = 0.021 and P = 0.020, respectively). There were small to moderate negative correlations between amount of smoking and preoperative physical functioning, role limitations from emotional problems, energy/fatigue, emotional well-being, and pain domains of the SF-36. However, there were moderate to strong negative correlations between amount of smoking and postoperative SF-36 domains.
Conclusion
Preoperative and postoperative functional outcome scores, and quality of life measurements are negatively affected from smoking. As the amount of smoking increases, postoperative results are negatively affected.
Level of evidence
3.
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References
Fehringer, E. V., Sun, J., VanOeveren, L. S., Keller, B. K., & Matsen, F. A., 3rd. (2008). Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. Journal of Shoulder and Elbow Surgery, 17(6), 881–885. https://doi.org/10.1016/j.jse.2008.05.039 (Epub 2008/09/09, PMID: 18774738).
Meyer, M., Klouche, S., Rousselin, B., Boru, B., Bauer, T., & Hardy, P. (2012). Does arthroscopic rotator cuff repair actually heal? Anatomic evaluation with magnetic resonance arthrography at minimum 2 years follow-up. Journal of Shoulder and Elbow Surgery, 21(4), 531–536. https://doi.org/10.1016/j.jse.2011.02.009 (Epub 2011/05/24, PMID: 21600793).
Oh, J. H., Kim, S. H., Ji, H. M., Jo, K. H., Bin, S. W., & Gong, H. S. (2009). Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome. Arthroscopy, 25(1), 30–39. https://doi.org/10.1016/j.arthro.2008.08.010 (Epub 2008/12/30, PMID: 19111216).
Raman, J., Walton, D., MacDermid, J. C., & Athwal, G. S. (2017). Predictors of outcomes after rotator cuff repair—a meta-analysis. Journal of Hand Therapy, 30(3), 276–292. https://doi.org/10.1016/j.jht.2016.11.002 (Epub 2017/02/27, PMID: 28237073).
Abtahi, A. M., Granger, E. K., & Tashjian, R. Z. (2015). Factors affecting healing after arthroscopic rotator cuff repair. World Journal of Orthopedics, 6(2), 211–220. https://doi.org/10.5312/wjo.v6.i2.211 (Epub 2015/03/21, PMID: 25793161).
Chung, S. W., Kim, J. Y., Yoon, J. P., Lyu, S. H., Rhee, S. M., & Oh, S. B. (2015). Arthroscopic repair of partial-thickness and small full-thickness rotator cuff tears: tendon quality as a prognostic factor for repair integrity. American Journal of Sports Medicine, 43(3), 588–596. https://doi.org/10.1177/0363546514561004 (Epub 2014/12/24, PMID: 25535097).
Abate, M., Schiavone, C., Salini, V., & Andia, I. (2013). Occurrence of tendon pathologies in metabolic disorders. Rheumatology (Oxford), 52(4), 599–608. https://doi.org/10.1093/rheumatology/kes395 (Epub 2013/01/15, PMID: 23315787).
Bedi, A., Fox, A. J., Harris, P. E., Deng, X. H., Ying, L., Warren, R. F., et al. (2010). Diabetes mellitus impairs tendon-bone healing after rotator cuff repair. Journal of Shoulder and Elbow Surgery, 19(7), 978–988. https://doi.org/10.1016/j.jse.2009.11.045 (Epub 2010/03/23, PMID: 20303293).
West, R. (2017). Tobacco smoking: health impact, prevalence, correlates and interventions. Health Psychology, 32(8), 1018–1036. https://doi.org/10.1080/08870446.2017.1325890 (Epub 2017/05/30, PMID: 28553727).
Carbone, S., Gumina, S., Arceri, V., Campagna, V., Fagnani, C., & Postacchini, F. (2012). The impact of preoperative smoking habit on rotator cuff tear: cigarette smoking influences rotator cuff tear sizes. Journal of Shoulder and Elbow Surgery, 21(1), 56–60. https://doi.org/10.1016/j.jse.2011.01.039 (Epub 2011/04/29, PMID: 21524922).
Bishop, J. Y., Santiago-Torres, J. E., Rimmke, N., & Flanigan, D. C. (2015). Smoking predisposes to rotator cuff pathology and shoulder dysfunction: A systematic review. Arthroscopy, 31(8), 1598–1605. https://doi.org/10.1016/j.arthro.2015.01.026.
Naimark, M., Robbins, C. B., Gagnier, J. J., Landfair, G., Carpenter, J., Bedi, A., et al. (2018). Impact of smoking on patient outcomes after arthroscopic rotator cuff repair. BMJ Open Sport and Exercise Medicine., 4(1), e000416. https://doi.org/10.1136/bmjsem-2018-000416 (Epub 2018/12/18, PMID: 30555715).
Galatz, L. M., Silva, M. J., Rothermich, S. Y., Zaegel, M. A., Havlioglu, N., & Thomopoulos, S. (2006). Nicotine delays tendon-to-bone healing in a rat shoulder model. Journal of Bone and Joint Surgery America., 88(9), 2027–2034. https://doi.org/10.2106/jbjs.E.00899 (Epub 2006/09/05, PMID: 16951120).
Baumgarten, K. M., Gerlach, D., Galatz, L. M., Teefey, S. A., Middleton, W. D., Ditsios, K., et al. (2010). Cigarette smoking increases the risk for rotator cuff tears. Clinical Orthopaedics and Related Research, 468(6), 1534–1541. https://doi.org/10.1007/s11999-009-0781-2 (Epub 2009/03/14, PMID: 19283436).
Santiago-Torres, J., Flanigan, D. C., Butler, R. B., & Bishop, J. Y. (2015). The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review. American Journal of Sports Medicine, 43(3), 745–751. https://doi.org/10.1177/0363546514533776 (Epub 2014/05/27, PMID: 24859982).
Pedowitz, R. A., Yamaguchi, K., Ahmad, C. S., Burks, R. T., Flatow, E. L., Green, A., et al. (2011). Optimizing the management of rotator cuff problems. Journal of the American Academy of Orthopaedic., 19(6), 368–379. https://doi.org/10.5435/00124635-201106000-00007 (Epub 2011/06/02, PMID: 21628648).
DeOrio, J. K., & Cofield, R. H. (1984). Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. Journal of Bone and Joint Surgery. American Volume, 66(4), 563–567. (Epub 1984/04/01 PMID: 6707035).
Park, J. H., Oh, K. S., Kim, T. M., Kim, J., Yoon, J. P., Kim, J. Y., et al. (2018). Effect of smoking on healing failure after rotator cuff repair. American Journal of Sports Medicine, 46(12), 2960–2968. https://doi.org/10.1177/0363546518789691 (Epub 2018/08/22, PMID: 30129777).
Mallon, W. J., Misamore, G., Snead, D. S., & Denton, P. (2004). The impact of preoperative smoking habits on the results of rotator cuff repair. Journal of Shoulder and Elbow Surgery, 13(2), 129–132. https://doi.org/10.1016/j.jse.2003.11.002 (Epub 2004/03/05, PMID: 14997086).
Balyk, R., Luciak-Corea, C., Otto, D., Baysal, D., & Beaupre, L. (2008). Do outcomes differ after rotator cuff repair for patients receiving workers’ compensation? Clinical Orthopaedics and Related Research, 466(12), 3025–3033. https://doi.org/10.1007/s11999-008-0475-1 (Epub 2008/09/11, PMID: 18784971).
Baumgarten, K. M., Schweinle, W. E., & Chang, P. S. (2020). Do patients who smoke tobacco have success with primary arthroscopic rotator cuff repair? A comparison with nonsmokers. Journal of Shoulder and Elbow Surgery., 29(8), 1650–1655. https://doi.org/10.1016/j.jse.2019.12.034.
McElvany, M. D., McGoldrick, E., Gee, A. O., Neradilek, M. B., & Matsen, F. A., 3rd. (2015). Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. American Journal of Sports Medicine., 43(2), 491–500. https://doi.org/10.1177/0363546514529644 (Epub 2014/04/23, PMID: 24753240).
Prasad, N., Odumala, A., Elias, F., & Jenkins, T. (2005). Outcome of open rotator cuff repair. An analysis of risk factors. Acta Orthopaedica Belgica., 71(6), 662–666. (Epub 2006/02/08. PMID: 16459854).
Lambers Heerspink, F. O., Dorrestijn, O., van Raay, J. J., & Diercks, R. L. (2014). Specific patient-related prognostic factors for rotator cuff repair: a systematic review. Journal of Shoulder and Elbow Surgery., 23(7), 1073–1080. https://doi.org/10.1016/j.jse.2014.01.001 (Epub 2014/04/15, PMID: 24725900).
Kane, S., Conus, S., Haltom, D., Hirshorn, K., Pak, Y., & Vigdorchik, J. (2010). A shoulder health survey: correlating behaviors and comorbidities with shoulder problems. Sports Health., 2(2), 119–134. https://doi.org/10.1177/1941738109338358 (Epub 2010/03/01, PMID: 23015930).
Titchener, A. G., White, J. J., Hinchliffe, S. R., Tambe, A. A., Hubbard, R. B., & Clark, D. I. (2014). Comorbidities in rotator cuff disease: a case-control study. Journal of Shoulder and Elbow Surgery., 23(9), 1282–1288. https://doi.org/10.1016/j.jse.2013.12.019 (Epub 2014/03/13, PMID: 24618192).
Ichinose, R., Sano, H., Kishimoto, K. N., Sakamoto, N., Sato, M., & Itoi, E. (2010). Alteration of the material properties of the normal supraspinatus tendon by nicotine treatment in a rat model. Acta Orthopaedica., 81(5), 634–638. https://doi.org/10.3109/17453674.2010.524595 (Epub 2010/10/06, PMID: 20919810).
Lundgreen, K., Lian, O. B., Scott, A., Nassab, P., Fearon, A., & Engebretsen, L. (2014). Rotator cuff tear degeneration and cell apoptosis in smokers versus nonsmokers. Arthroscopy, 30(8), 936–941. https://doi.org/10.1016/j.arthro.2014.03.027 (Epub 2014/05/28, PMID: 24863404).
Randelli, P., Spennacchio, P., Ragone, V., Arrigoni, P., Casella, A., & Cabitza, P. (2012). Complications associated with arthroscopic rotator cuff repair: a literature review. Musculoskeleton Surgery., 96(1), 9–16. https://doi.org/10.1007/s12306-011-0175-y (Epub 2011/12/30, PMID: 22205384).
Heyer, J. H., Kuang, X., Amdur, R. L., & Pandarinath, R. (2018). Identifiable risk factors for thirty-day complications following arthroscopic rotator cuff repair. Physician and Sportsmedicine., 46(1), 56–60. https://doi.org/10.1080/00913847.2018.1388732 (Epub 2017/10/05, PMID: 28974126).
Oh, S. W., Yoon, Y. S., Lee, E. S., Kim, W. K., Park, C., Lee, S., et al. (2005). Association between cigarette smoking and metabolic syndrome: the Korea National Health and Nutrition Examination Survey. Diabetes Care, 28(8), 2064–2066. https://doi.org/10.2337/diacare.28.8.2064 (Epub 2005/07/27, PMID: 16043763).
Abboud, J. A., & Kim, J. S. (2010). The effect of hypercholesterolemia on rotator cuff disease. Clinical Orthopaedics and Related Research, 468(6), 1493–1497. https://doi.org/10.1007/s11999-009-1151-9 (PMID: 19885710).
Cho, N. S., Moon, S. C., Jeon, J. W., & Rhee, Y. G. (2015). The influence of diabetes mellitus on clinical and structural outcomes after arthroscopic rotator cuff repair. American Journal of Sports Medicine., 43(4), 991–997. https://doi.org/10.1177/0363546514565097 (Epub 2015/01/28, PMID: 25622985).
Laaksonen, M., Rahkonen, O., Martikainen, P., Karvonen, S., & Lahelma, E. (2006). Smoking and SF-36 health functioning. Preventive Medicine., 42(3), 206–209. https://doi.org/10.1016/j.ypmed.2005.12.003 (Epub 2006/01/31, PMID: 16443264).
Mulder, I., Tijhuis, M., Smit, H. A., & Kromhout, D. (2001). Smoking cessation and quality of life: the effect of amount of smoking and time since quitting. Preventive Medicine., 33(6), 653–660. https://doi.org/10.1006/pmed.2001.0941 (Epub 2001/11/22, Epub 2001/11/22).
Woolf, S. H., Rothemich, S. F., Johnson, R. E., & Marsland, D. W. (1999). Is cigarette smoking associated with impaired physical and mental functional status? An office-based survey of primary care patients. American Journal of Preventive Medicine., 17(2), 134–137. https://doi.org/10.1016/s0749-3797(99)00060-4 (Epub 1999/09/18, PMID: 10490056).
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Ozcamdalli, M., Kizkapan, T.B., Misir, A. et al. Effect of Smoking on Postoperative Function and Quality of Life After Full Thickness Arthroscopic Rotator Cuff Repair: A Retrospective Analysis. JOIO 55, 464–470 (2021). https://doi.org/10.1007/s43465-020-00339-5
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DOI: https://doi.org/10.1007/s43465-020-00339-5