title: The effect of smoking on ligament and cartilage surgery in the knee: a systematic review.
abstract: BACKGROUND
  The adverse effects of smoking on various health conditions such as cancer, diabetes, and cardiovascular disease have been well documented. Many orthopaedic conditions, such as fracture healing, wound repair, and bone mineral density, have been reported to be adversely affected by smoking. However, no known systematic reviews have investigated the effects of smoking on ligament and cartilage knee surgery.
  
  
  OBJECTIVE
  We hypothesized that smoking would have a negative influence from both a basic science and clinical outcome perspective on these types of knee surgeries.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  A systematic review of multiple medical databases was performed evaluating clinical and basic science studies to determine the effects of smoking on ligament and cartilage knee surgery.
  
  
  RESULTS
  Fourteen studies were found for inclusion and analysis. Eight of these studies addressed the relationship between smoking and knee ligaments, and 6 investigated the relationship between smoking and articular cartilage. With the exception of 1, all of the basic science and clinical studies exploring the relationship between smoking and knee ligaments found a negative association of smoking, either molecularly, biomechanically, or clinically. One basic science and 3 clinical studies found a negative influence of smoking on articular cartilage of the knee. No studies were found that investigated the relationship of smoking and menisci.
  
  
  CONCLUSIONS
  The current literature reveals a negative influence of smoking on the results of knee ligament surgery, both from a basic science and clinical perspective, implying that smoking cessation would benefit patients undergoing these procedures. The association between smoking and knee articular cartilage was less clear, although the literature still suggests an overall negative influence and highlights the need for further investigation.
authors.affiliation: The Ohio State University Sports Medicine Center, Columbus, OH 43221-3502, USA.
authors.forename: Praveen
authors.initials: P
authors.lastname: Kanneganti
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Harris
authors.forename: Robert H
authors.initials: RH
authors.lastname: Brophy
authors.forename: James L
authors.initials: JL
authors.lastname: Carey
authors.forename: Christian
authors.initials: C
authors.lastname: Lattermann
authors.forename: David C
authors.initials: DC
authors.lastname: Flanigan
mesh_terms: D002358:Cartilage, Articular / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D012907:Smoking / Q000009:adverse effects*