Smoking Increases the Risk of Early Meniscus Repair Failure

Abstract

Objectives: Meniscus tears are among the most common surgically treated knee injuries. Numerous studies have demonstrated increased risk of the development of radiographic signs of osteoarthritis following meniscus loss, leading surgeons to attempt to repair and preserve the meniscus whenever possible. Tear location and morphology, knee stability, the performance of a concurrent anterior cruciate ligament (ACL) reconstruction, and patient age have in various studies been correlated with risk of repair failure. While smoking has been demonstrated to in orthopaedics to impair wound healing, fracture union, and spinal fusion; there are no studies in the literature evaluating the effect of smoking on meniscus repair. We hypothesize that smoking is associated with increased risk of meniscus repair failure, defined as performance of a subsequent partial meniscectomy following initial meniscus repair. Methods: Patients who underwent meniscus repair by two surgeons at a single center between 2006 and 2012 were retrospectively identified through chart review. Patient demographics and smoking status were documented. Each smoking patient was subsequently matched to a nonsmoking using patient who underwent meniscus repair in the same period by age (within 5 years), sex, and whether a concurrent ACL reconstruction was performed. Matching was performed without knowledge of outcome. Further chart review was subsequently undertaken to identify whether a subsequent meniscectomy was performed in the same compartment during the follow-up period. Meniscectomy risk was compared between smokers and nonsmokers using McNemar's test. Results: Chart review identified 68 smokers who underwent meniscus repair during the study period. The group included 43 males (63.2%), had a mean age of 29.0 ± 8.5 years, and included 49 patients (72.1%) who underwent concurrent ACL reconstruction. The matched group of nonsmokers included 43 males (63.2%), had a mean age of 29.2 ± 8.3 years, and included 49 patients (72.1%) who underwent concurrent ACL reconstruction. At a mean follow-up of 15 months, subsequent partial meniscectomy was performed in 16 smokers (23.5%) and 7 nonsmokers (10.3%) (p = 0.029). The relative risk of subsequent partial meniscectomy in smokers relative to nonsmokers was 2.28 (95% CI: 1.07 to 4.90). Conclusion: After controlling for age, sex, and concurrent ACL reconstruction, current smokers were significantly more likely to undergo meniscectomy in the first 15 months following meniscus repair. Further study is necessary to confirm these findings and determine the impact of other factors such as tear location and morphology, meniscal repair technique, and activity level on the findings.