Smokers present a three times higher risk of graft failure after ACL reconstruction: A single-centre retrospective analysis

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-09-10 DOI:10.1002/jeo2.70422

Filip R. Hendrikx, Pietro Conte, Annemieke Van Haver, Kristien Vuylsteke, Koen Carl Lagae, Peter Verdonk

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Abstract

Purpose

To determine whether patients actively smoking at the time of primary anterior cruciate ligament reconstruction (ACLR) have higher failure rates, defined as the need for revision ACLR procedures over time, compared to non-smokers.

Methods

This was a retrospective evaluation on a single-centre cohort of patients who underwent primary ACLR between 2010 and 2015. Patients were included if they had a minimum follow-up of two years and were classified according to their smoking status at the time of the surgery. The primary outcome was graft failure, defined as the need for revision ACLR surgery due to symptomatic ACL instability. Additionally, subgroup analyses were performed on patient groups known to be at high risk of ACLR failure.

Results

The cohort consisted of 537 patients, including 96 (18%) smokers and 441 (82%) non-smokers, with a mean follow-up of 56 months (range 24–89). Demographic characteristics were similar between smokers and non-smokers at baseline. Overall, 22 patients (4.1%) underwent revision ACLR. The failure rate was significantly higher in smokers (9.4%, 9/96) compared to non-smokers (2.9%, 13/441) (p = 0.008, odds-ratio (OR): 3.41, 95% confidence interval (CI): 1.41–8.22). This difference was even greater in specific subgroups: smokers had significantly higher failure rates than non-smokers among patients under 25 years of age (31% vs. 9.8%, p = 0.006, OR: 4.13, 95% CI: 1.54–11.07), highly active patients (20.7% vs. 7.7%, p = 0.044; OR; 3.13, 95% CI: 1.01–9.30) and male patients (13.3% vs. 3.9%, p = 0.010; OR: 3.83, 95% CI: 1.41–10.40).

Conclusions

Smoking at the time of ACLR was associated with a threefold increased risk of ACLR failure. The ACLR failure risk was even greater in patients under 25 years of age, male and those participating in high-activity sports. Notably, a failure rate of 31% was observed in smokers under 25 years of age.

Level of Evidence

Level IV, case series with no comparison group.

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吸烟者在ACL重建后移植物失败的风险高出三倍：一项单中心回顾性分析

目的：研究原发性前交叉韧带重建术（ACLR）时吸烟的患者是否比不吸烟者有更高的失败率（定义为随着时间的推移需要对ACLR进行翻修）。方法对2010年至2015年间接受原发性ACLR的单中心队列患者进行回顾性评估。如果患者至少有两年的随访，并根据他们在手术时的吸烟状况进行分类，则纳入患者。主要结果是移植物失败，定义为由于症状性前交叉韧带不稳定需要翻修ACLR手术。此外，对已知ACLR衰竭高风险的患者组进行亚组分析。结果该队列包括537例患者，其中96例（18%）吸烟者和441例（82%）非吸烟者，平均随访56个月（范围24-89）。吸烟者和非吸烟者在基线时的人口学特征相似。总体而言，22例患者（4.1%）接受了改良ACLR。吸烟者的失败率（9.4%,9/96）显著高于非吸烟者（2.9%,13/441）（p = 0.008，比值比（OR）： 3.41, 95%可信区间（CI）： 1.41 ~ 8.22）。这种差异在特定亚组中甚至更大：在25岁以下患者中，吸烟者的失败率明显高于非吸烟者（31%比9.8%,p = 0.006, OR: 4.13, 95% CI: 1.54-11.07），高度活跃患者（20.7%比7.7%,p = 0.044； OR; 3.13, 95% CI: 1.01-9.30）和男性患者（13.3%比3.9%,p = 0.010; OR: 3.83, 95% CI: 1.41-10.40）。结论：ACLR时吸烟与ACLR衰竭风险增加三倍相关。25岁以下的患者、男性和参加高强度运动的患者的ACLR衰竭风险更大。值得注意的是，在25岁以下的吸烟者中，失败率为31%。证据水平：IV级，病例系列，无对照组。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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