title: Graft selection in anterior cruciate ligament reconstruction for smoking patients.
abstract: BACKGROUND
  There has been no previous study regarding graft selection in anterior cruciate ligament (ACL) reconstruction for smoking patients.
  
  
  OBJECTIVE
  To compare the clinical outcomes of ACL reconstruction between smokers and nonsmokers and to find an optimal graft in ACL reconstruction with regard to clinical outcomes for smoking patients.
  
  
  METHODS
  Cohort study; Level of evidence, 2.
  
  
  METHODS
  A total of 487 patients who underwent unilateral ACL reconstruction were retrospectively reviewed. Included patients were divided into 2 groups according to their history of smoking. Group 1 was composed of patients who had never smoked (n = 322), and group 2 consisted of patients who had reported smoking before ACL reconstruction and during rehabilitation (n = 165). Additionally, each group was divided into 4 subgroups according to the selected graft type (bone-patellar tendon-bone autograft, hamstring [semitendinosus-gracilis] tendon autograft, quadriceps tendon-bone autograft, or Achilles tendon-bone allograft). Patients were assessed for knee instability with the Lachman and pivot-shift tests as well as anterior translation measured by the KT-2000 arthrometer. Functional outcomes were evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective score, and IKDC objective grade.
  
  
  RESULTS
  The minimum follow-up period was 24 months. At the final follow-up evaluation, there were significant mean between-group differences regarding the side-to-side difference in anterior translation (group 1, 2.15 ± 1.11 mm; group 2, 2.88 ± 1.38 mm; P < .001), Lysholm knee score (group 1, 90.25 ± 6.18; group 2, 84.79 ± 6.67; P < .001), IKDC subjective score (group 1, 89.16 ± 5.01; group 2, 83.60 ± 7.48; P < .001), and IKDC objective grade (group 1, grade A = 151, B = 130, C = 36, D = 5 patients; group 2, grade A = 48, B = 71, C = 37, D = 9 patients; P < .001). With regard to differences in outcomes between the selected grafts within each group, the Achilles tendon-bone allograft showed the worst outcomes, with statistically significant mean differences for smoking patients in the side-to-side difference in anterior translation (3.59 ± 1.26 mm), Lysholm knee score (81.05 ± 2.82), and IKDC subjective score (79.73 ± 4.29).
  
  
  CONCLUSIONS
  Unsatisfactory outcomes with regard to stability and functional scores were shown in the smoking group compared with the nonsmoking group. In smokers, the patients receiving an Achilles tendon-bone allograft had poorer outcomes than those with autografts. The bone-patellar tendon-bone autograft is recommendable for ACL reconstruction in a smoking patient.
authors.affiliation: Min Jung, Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University College of Medicine, CPO Box 8044, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea. jmin1103@naver.com.
authors.forename: Sung-Jae
authors.initials: SJ
authors.lastname: Kim
authors.forename: Su-Keon
authors.initials: SK
authors.lastname: Lee
authors.forename: Chong Hyuk
authors.initials: CH
authors.lastname: Choi
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Seong-Hun
authors.initials: SH
authors.lastname: Kim
authors.forename: Min
authors.initials: M
authors.lastname: Jung
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation; D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction; D016025:Bone Transplantation / Q000379:methods*; D064594:Bone-Patellar Tendon-Bone Grafts; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: anterior cruciate ligament; arthroscopic surgery; graft; reconstruction; risk factor; smoking