The Effects of Smoking on Anterior Cruciate Ligament Reconstruction Outcomes

Introduction

The outcomes of anterior cruciate ligament (ACL) reconstruction have been known to be affected by many factors, including operative factors such as nonanatomic tunnel placement, improper graft tensioning and inadequate graft fixation, biologic failure according to the type of graft, untreated concomitant ligament injury, generalized laxity, and traumatic failure. In addition to these factors, cigarette smoking can be considered as one of the factors causing adverse effects on the outcomes of ACL reconstruction, considering vasoconstriction and hypoperfusion caused by cigarette smoking. Smoking has already been widely known to be a major cause of morbidity and mortality, and its relationship with cardiovascular and pulmonary disease has been well established. Studies have shown that postoperative complications are more prevalent among smokers than nonsmokers. In the field of orthopaedic surgery, smoking has been reported to have detrimental effects on fracture healing, spinal fusion, wound repair, bone mineral density, lumbar disc disease, and rate of hip fracture. Recently several studies regarding the relationship between cigarette smoking and outcomes of ACL reconstruction have been reported, and attention is being drawn to the adverse effect of smoking on ligament surgery.