Duration of Smoking Cessation Needed to Achieve Retear Rates Comparable to Those of Nonsmokers After Arthroscopic Rotator Cuff Repair

Abstract

Background:

Smoking increases retear rates after rotator cuff repair. However, the cessation duration required to achieve outcomes comparable to those of nonsmokers remains unclear.

Purpose:

To determine the cessation duration required for former smokers to achieve retear rates comparable to those of nonsmokers after arthroscopic rotator cuff repair.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The study included 1902 patients who underwent arthroscopic rotator cuff repair for full-thickness tears between March 2012 and October 2023. Patients were categorized as nonsmokers (1172 patients); former smokers stratified by cessation duration of <1 year, 1 to <3 years, 3 to <5 years, and ≥5 years (454 patients); or current smokers (276 patients). After 1:1:1 propensity score matching based on age, employment status, tear size, and fatty infiltration, the records of 276 patients per group were analyzed. The visual analog scale, Subjective Shoulder Value, American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and range of motion were used to compare functional outcomes. Six-month postoperative magnetic resonance imaging assessed structural integrity using the Sugaya classification.

Results:

At the 2-year (range, 23-27 months; mean, 24.5 ± 1.0 months) follow-up evaluation, clinical scores and range of motion had significantly improved (P < .001 for all) in all groups without significant intergroup differences. However, retear rates differed significantly: 17.8% in nonsmokers, 25.4% in former smokers, and 29.3% in current smokers (P = .005). Former smokers demonstrated progressively decreasing retear rates with longer cessation: 28.6% at <1 year, 27.0% at 1 to <3 years, 20.1% at 3 to <5 years, and 19.4% at ≥5 years. Patients with ≥3 years’ cessation achieved rates comparable to those of nonsmokers. Multivariable analysis identified smoking status, pack-years (cutoff, 14), and cessation duration (cutoff, 44 months) as independent predictors. The combined cessation duration/pack-year model demonstrated superior predictive performance (AUC, 0.716).

Conclusion:

Sustained smoking cessation significantly lowers retear rates after rotator cuff repair, with at least 3 years of abstinence required to achieve rates comparable to those of nonsmokers. Pack-years and duration of cessation serve as independent predictors of tendon healing.