Effect of Smoking on Healing Failure After Rotator Cuff Repair

Background: No study to date has directly evaluated rotator cuff repair results among smokers. Purpose: To evaluate whether smoking affects healing after arthroscopic rotator cuff repair through propensity score matching (PSM). Study Design: Cohort study; Level of evidence, 3. Methods: Among 249 patients who underwent arthroscopic repair of full-thickness rotator cuff tears, 34 current heavy smokers were selected with a smoking history >20 pack-years (mean ± SD pack-years, 33.91 ± 12.13). Characteristics between current heavy smokers and nonsmokers were compared. According to the PSM technique, 34 nonsmokers were selected after 1:1 matching for age, fatty infiltration, and tear size—the main prognostic factors of outcomes after rotator cuff repair. Each patient’s outcome evaluation was completed anatomically at a minimum of 6 months (magnetic resonance imaging or ultrasonography) and functionally at a minimum of 1 year (pain visual analog scale, range of motion, American Shoulder and Elbow Surgeons, Constant, University of California, Los Angeles, and Simple Shoulder Test scores), and every outcome was analyzed in the matched smoker and nonsmoker groups. Results: Current heavy smokers had a higher incidence of male sex (P <.001), heavy manual work (P =.025), high bone density (P =.036), and poor tendinosis grade (P =.028). After adjustment for the confounding variables by PSM, the matched smoker group showed a significantly higher healing failure rate than the matched nonsmoker group (29.4% vs 5.9%, P =.023). However, we failed to detect significant differences in the functional outcomes between the matched groups (P >.05). Conclusion: Smoking affected healing failure after arthroscopic rotator cuff repair. Attention should be paid to smokers, especially current heavy smokers, in cases of rotator cuff repair surgery.