title: The effect of smoking on ACL reconstruction: a systematic review.
abstract: OBJECTIVE
  Anterior cruciate ligament reconstruction (ACLR) depends on proper healing of the graft or bone plug at the cellular level. The effect of cigarette smoke on ACLR was not commonly reported until recently. The primary purpose of this review was to determine if smoking has a negative effect on subjective or objective outcome scores after ACLR. The secondary purpose was to identify any increased risk of complications, infection, ACL re-tear, or revision procedures.
  
  
  METHODS
  A systematic literature review of the MEDLINE, SCOPUS and PubMed databases was performed to identify all studies that compared outcomes of ACLR surgery between smokers and nonsmokers. The frequency-weighted mean was calculated for outcome measures that were similar across several studies.
  
  
  RESULTS
  Seventeen studies were identified that met inclusion criteria for patients undergoing ACLR (mean age, 26.8 years) with a mean follow-up of 37 months. Smokers had significantly worse subjective outcome measures and worse side-to-side difference in anterior translation compared to non-smokers (2.68 mm vs 1.89 mm, respectively). In 2 studies, smokers were found to have a significantly higher risk of developing an infection and VTE (venous thromboembolism) post-operatively. The evidence for the effect of smoking on risk for subsequent re-tear is mixed. No study reported a higher rate of development of radiographic knee osteoarthritis among smokers compared to nonsmokers.
  
  
  CONCLUSIONS
  Cigarette smoke is associated with significantly worse clinical outcome scores, an increase in anterior translation, and increased complication rates after ACL reconstruction. These findings may help orthopaedic surgeons better inform their patients about the potential negative effects of smoking on the outcomes of ACL reconstruction.
  
  
  METHODS
  Therapeutic Level IV.
authors.affiliation: a School of Medicine , Stony Brook University Health Sciences Center , Stony Brook , NY , USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Novikov
authors.affiliation: b NYU Langone Medical Center , Hospital for Joint Diseases , New York , NY , USA.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Swensen
authors.affiliation: b NYU Langone Medical Center , Hospital for Joint Diseases , New York , NY , USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Buza
authors.affiliation: b NYU Langone Medical Center , Hospital for Joint Diseases , New York , NY , USA.
authors.forename: Ramesh H
authors.initials: RH
authors.lastname: Gidumal
authors.affiliation: b NYU Langone Medical Center , Hospital for Joint Diseases , New York , NY , USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Strauss
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries / Q000209:etiology / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012421:Rupture / Q000209:etiology; D012907:Smoking / Q000009:adverse effects*
keywords: ACL; Anterior cruciate ligament; infection; outcomes; re-tear; smoking; tobacco