Examining the Evidence Regarding Smoking and Patient Outcomes for Isolated Meniscus Pathology: A Comprehensive Systematic Review and Meta-Analysis

Abstract

Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study assesses the relationship between smoking and meniscus treatment outcomes. PubMed, Scopus, Cochrane, and CINAHL were searched from inception to 24 December 2023. Inclusion criteria encompassed studies examining smoking's impact on patient outcomes regarding meniscus pathology. A secondary PubMed search targeted randomized controlled trials (RCTs) in the top ten orthopedic journals focusing on meniscus pathology and smoking as a demographic variable. Meta-analysis of six studies (n = 528) assessed meniscus failure rate based on smoking status. Eighteen observational studies (n = 8353 patients; 53.25% male; mean age: 51.35 ± 11.53 years; follow-up: 184.11 ± 117.34 months) were analyzed, covering meniscus repair, meniscectomy, allograft transplant, conservative care, and arthroscopy. Results showed four studies (36.36%) linked smoking with worse meniscus repair outcomes, while seven studies (63.64%) did not find significant associations. Meta-analysis from six studies showed no significant impact of smoking on repair failure (p = 0.118). Regarding meniscectomy, one study (33.33%) identified a significant association with smoking, but two did not. Only one (3.8%) of the RCTs in leading orthopedic journals included smoking as a factor. The evidence on smoking's effect on meniscus treatment is mixed, necessitating further investigation.

Keywords: meniscectomy; meniscus; meniscus repair; meniscus tear; smoking; tobacco.

Figure 1

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram outlining the entire search progress, from initial search in four databases to final article inclusion.

Figure 2

Random-effects model forest plot demonstrating relationship between meniscus failure and smoking status. Effect measures used were ORs and CIs. Abbreviations: SM, smokers; NS, nonsmokers; fail; failure; OR, odds ratio; CI, confidence interval. Heterogeneity: Tau-squared = 0.44, H-squared = 1.64, I-squared = 0.39. Axis is shown using log scale [14,15,32,33,36,43].