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

Objective(s): To examine the association between smoking and patient outcomes for meniscus pathology while assessing the current state of the literature to improve risk-stratification and patient education.

Data Sources: PubMed, Scopus, Cochrane, and CINAHL were searched from database inception to December 24, 2023 for primary search

Study Selection: Inclusion criteria for the primary search included studies that examined the relationship between smoking and patient outcomes specific for meniscus pathology with eighteen articles meeting inclusion criteria. Additionally, a second search was performed using PubMed to examine randomized controlled trials (RCTs) from the top ten orthopedic journals that focused on meniscus pathology with 53 articles meeting inclusion criteria. RCTs were then examined for the inclusion of smoking as a patient demographic or variable.

Data Extraction: Data was extracted by multiple authors. Data extracted included study type, surgery type, total patients, sex, patient age, follow-up time, significant findings regarding smoking and tears, number of postoperative failures, and reporting of smoking status. .

Data Synthesis: Eleven studies investigated smoking and meniscus repair in the primary search. For smoking and meniscus repair, four studies found a significant association whereas seven studies did not. Meta-analysis from six studies found no significant association between smoking and failure after meniscus repair (p=0.118). One study found significant association between smoking and meniscectomy whereas two studies did not. Furthermore, one study found an association between meniscus allograft transplant and smoking whereas one study did not. Only two out of 53 RCTs regarding meniscus pathology in the top ten orthopedic journals examined smoking in the patient cohort.

Conclusions: There appears to be mixed evidence regarding the relationship between smoking and meniscus pathology in observational studies, with scarce high-quality data on this topic. Further research is needed to determine the association between smoking and meniscus pathology to improve patient care.

Author(s) Disclosures: The authors have no relevant disclosures to make known at this time.