Several factors have been reported to adversely affect clinical and structural outcomes
after rotator cuff repair (RCR). However, the effects of smoking on rotator cuff healing
and clinical outcomes remain controversial. The purpose of this study was to compare
the clinical and structural outcomes after RCR between smokers and nonsmokers. We
hypothesized that there would be no significant difference in the clinical scores
after RCR and that smoking would be associated with a significantly increased risk
of retear and reoperation.
This systematic review was performed in accordance with the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses guidelines using the PubMed, Cochrane Library,
and Embase databases. Only articles with patients undergoing arthroscopic and open
RCR, that reported the clinical outcome scores for smokers and nonsmokers, and that
reported the number of rotator cuff retears and reoperations were included. Data relevant
to this study were extracted and statistically analyzed. We used the Newcastle-Ottawa
Scale to assess the risk of bias in each study and calculated the I2 value to quantify the effect of heterogeneity.
Fourteen eligible articles were identified, with 73,817 participants (n = 8,553, smokers;
n = 65,264, nonsmokers). The meta-analysis demonstrated that there were no significant
differences in the American Shoulder and Elbow Surgeons score (P = 0.10), Simple Shoulder Test score (P = 0.19), University of California-Los Angeles score (P = 0.09), or Visual Analog Scale (P = 0.19) between smokers and nonsmokers after surgery, but the Constant score was
significantly lower (P = 0.005) for smokers. However, smoking was significantly associated with an increased
risk of retear (P = 0.002; RR, 2.06 [95% CI, 1.30–3.28]; I2 = 31%) and reoperation (P < 0.001; RR, 1.29 [95% CI, 1.20–1.40]; I2 = 36%) in patients after RCR.
Besides the Constant score, which was lower in smokers, there were no significant
differences in the clinical scores after RCR between smokers and nonsmokers. However,
smoking was associated with a significantly increased risk of retear and reoperation.
Level of evidence
Level III; Systematic Review/Meta-Analysis