Tobacco use and increased risk of ACL and meniscus injury and surgical intervention: a matched-cohort study of 3 million patients
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction: Meniscus and anterior cruciate ligament (ACL) tears or strains make up the majority of the most commonly reported knee injuries. While current literature demonstrates associations between tobacco use and meniscus or ACL reconstruction postoperative complications, there is little to no data analyzing any risks that tobacco use may have on the development of these injuries, the need for subsequent surgery, or the impact on hospital lengths of stay. Therefore, the purpose of this study was to determine if individuals who use tobacco are at increased odds of: (1) Meniscus or ACL injury; (2) meniscus or ACL reconstructive surgery; and (3) hospital lengths of stay. Methods A Humana patient population consisting of 8 million lives was retrospectively analyzed from 2007 to 2017 using International Classification of Diseases, 9th Revision (ICD-9) and 10th Revision (ICD-10) codes. Patients who used tobacco were identified and matched to non-tobacco user controls in a 1:1 ratio according to age and medical comorbidities. The query yielded 3,310,668 patients with (n = 1,655,334) and without (n = 1,655,334) tobacco use disorder. Primary outcomes analyzed included: incidence of meniscus or ACL injury; (2) incidence of meniscus or ACL reconstructive surgery; and (3) post-surgical hospital lengths of stay. Logistic regression was used to calculate odds ratios (OR) for meniscus and ACL injury, and meniscus and ACL reconstructive surgery. Welch’s t-test was used to test for significance in the length of stay. A p-value less than 0.05 was considered statistically significant. Results Tobacco users were found to have increased incidence and odds (3.43 vs. 3.28%; OR: 1.10, p < 0.0001) of meniscus tear and increased incidence and odds (0.48 vs 0.41%; OR: 1.15, p < 0.0001) of ACL injury. Tobacco users with meniscal injury and tobacco users with ACL injury were found to have increased incidence and odds of surgical repair (0.60 vs. 0.47%; OR: 1.27, p < 0.0001; 11.45 vs. 9.42%; OR: 1.24, p < 0.0001, respectively). Additionally, tobacco users were found to have greater postoperative hospital length of stay compared to non-tobacco-using controls. Conclusion This analysis of over 3 million patients demonstrates that tobacco use increases the incidence and odds of both meniscus and ACL injury, surgical repair, and postoperative hospital length of stay. Additionally, tobacco use appears to increase the need for subsequent surgical repair after meniscus or ACL injury. Level of Evidence III
Source: Scientific Reports
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,690
OpenAlex ID: W7164337766