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Cigarette Smoking Delays Ligament Healing

r to MCL surgery and then again after surgery to mimic the behavior of humans who continue to smoke following an injury.

The researchers say athletes who smoke should keep these findings in mind before driving for a lay-up, sliding into second base or lacing up a pair of ice skates.

The soft tissue healing that occurs following ligament injuries occurs in stages. There is an immediate pooling of blood near the injury, the sort of hemorrhaging that will cause swelling right away. This initial response is followed by several days of inflammation, in which cells called macrophages flock to the injury site and secrete substances called cytokines and chemokines.

Those, in turn, recruit more cells to assist in healing. That process of cellular proliferation and synthesis lasts for several days to several weeks. The final stage of healing involves remodeling of the tissue and can continue for months and even years.

An earlier study found an increase in cell density and in gene activity to produce type I collagen in the first week following MCL injury, so in this study the researchers paid close attention to cell density, biomechanical function and gene expression during the first week after MCL repair. In mice exposed to cigarette smoke, cell density was lower and type I collagen gene expression was reduced.

"Our studies also have shown a decreased macrophage response that may help explain why we see this delayed or decreased healing response," Wright says.

Between 20 and 25 percent of the U.S. population smokes. Wright and Sandell say that although the prevalence of smoking among athletes is slightly lower, a significant percentage of recreational and even professional athletes continue to smoke. Many others use chewing tobacco, which may cause some of the same effects. But that's not yet clear since the mice in this study were exposed to smoke rather than to nicotine only.

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