title: The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review.
abstract: BACKGROUND
  Several orthopaedic conditions have been reported to be adversely affected by smoking. Only a few studies have looked at outcomes related to smoking in shoulder surgery.
  
  
  OBJECTIVE
  To determine whether smoking has a negative influence on tendinous, ligamentous, and cartilaginous shoulder surgery. The hypothesis was that smoking has a negative influence from both a basic science and clinical outcomes perspective on soft tissue shoulder surgery.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  A systematic review of multiple medical databases was performed evaluating clinical outcomes and basic science studies to determine the effects of smoking on tendinous, ligamentous, and cartilaginous shoulder surgery. The search strategy was based on "shoulder AND [smoke OR smoking OR nicotine OR tobacco]." English language clinical outcomes or basic science studies following soft tissue surgery of the shoulder were included. Studies excluded consisted of those with evidence level 5, partial or total shoulder arthroplasty, fracture reduction and fixation, oncologic mass excision, and osteotomy around the shoulder.
  
  
  RESULTS
  Ten studies were identified for inclusion and analysis. Eight of these studies, which included 1 basic science study, investigated the relationship between smoking and outcomes of rotator cuff repair (RCR), and 2 examined the effects of smoking on outcomes of glenoid labrum repair. No studies were found that specifically explored the effects of smoking on cartilaginous shoulder surgery. The basic science study and 3 of the 7 clinical outcomes studies investigating smoking and rotator cuff (RTC) surgery outcomes found a statistically significant negative association resulting in decreased RTC tendon repair quality, decreased biomechanics, poorer clinical outcomes, and impaired healing of small-medium RTC tears as assessed by magnetic resonance imaging. In addition, 1 of 2 clinical outcomes studies examining smoking and glenoid labrum repair reported an increased need for surgical revision of superior labral anterior to posterior (SLAP) tears in smokers. No basic science studies were found that investigated the effects of smoking on glenoid labrum surgery.
  
  
  CONCLUSIONS
  Smoking has a negative influence on RCR clinical outcomes and is associated with decreased healing of small-medium RTC tears after repair. The current literature suggests a negative influence of nicotine and smoking on RCR from both a basic science and clinical outcomes perspective. Smoking cessation would benefit patients undergoing RCR and improve clinical outcomes. The relationship of smoking and labral/SLAP repair or articular cartilage is less clear. Further research is needed to evaluate associations with these surgeries and outcomes.
  
  
  CONCLUSIONS
  Smoking has a negative influence on RCR clinical outcomes and is associated with decreased healing of small-medium RTC tears after repair.
authors.affiliation: OSU Sports Medicine and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Santiago-Torres
authors.affiliation: OSU Sports Medicine and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Flanigan
authors.affiliation: Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: R Bryan
authors.initials: RB
authors.lastname: Butler
authors.affiliation: OSU Sports Medicine and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA Julie.Bishop@osumc.edu.
authors.forename: Julie Y
authors.initials: JY
authors.lastname: Bishop
mesh_terms: D001696:Biomechanical Phenomena; D006801:Humans; D008279:Magnetic Resonance Imaging; D012086:Reoperation; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012540:Scapula / Q000293:injuries / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome; D014945:Wound Healing
keywords: glenoid labrum repair; rotator cuff repair; smoking