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Cigarette Smoking Impedes Tendon-to-Bone Healing

Orthopaedic surgery researchers at Washington University School of Medicine in St. Louis have identified yet another reason not to smoke. Studying rotator cuff injury in rats,// the research team found exposure to nicotine delays tendon-to-bone healing, suggesting this could cause failure of rotator cuff repair following surgery in human patients.

Smoking is implicated in a host of physical problems, from cardiovascular disease to lung disorders. Many of us probably don't think about smoking's effects on orthopaedic conditions, but several studies have shown that nicotine interferes with healing of bone fractures and also inhibits bone fusion processes — many spine surgeons, for example, won't do certain operations on people who smoke because of the risk of failure. But little is known about the effects of cigarettes on tendon and ligament healing.

There also are some gaps in medical knowledge about the prevalence of rotator cuff injuries. The rotator cuff is a group of four muscles and their tendons in the shoulder that provide rotation, elevate the arm and stabilize the shoulder joint. Rotator cuff tears involve one or more of the tendons. The injuries are more common as people age and more common in the dominant arm. The true incidence of the injuries is hard to determine because between 5 percent and 40 percent of people who may have a torn rotator cuff have no accompanying shoulder pain.

What surgeons do know is that rotator cuff repairs can fail in the days and weeks after surgery. Some studies have reported short- to intermediate-term recurrence rates from 30 percent to 90 percent, depending on the size of the tear, chronic nature of the injury and the age of the patient, among other factors.

"Especially during the first six weeks after surgery, tissue may be vulnerable to re-injury," says Leesa M. Galatz, M.D., first author of the study and assistant professor of orthopaedic surgery at Washington University Sch
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