DOI: 10.1177/03635465261459231 ISSN: 0363-5465

The Effect of Smoking History on Inflammatory Biomarkers in Synovial Fluid of Patients Undergoing Arthroscopic Knee Surgery for Meniscal Injury

Jessica L. Kurtz, Mallory Ehlers, Samuel R. Montgomery, Daniel J. Kaplan, Eric J. Strauss
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Background:

Smoking has been linked to alterations in cellular inflammatory pathways and adverse outcomes in orthopaedic procedures. It is unclear how patient smoking affects the intra-articular microenvironment in the setting of symptomatic meniscal tears.

Purpose:

To investigate the association between tobacco use and variation in cytokine concentrations in knee synovial fluid in patients undergoing arthroscopic knee surgery for symptomatic meniscal injury.

Study Design:

Cohort study; Level of evidence, 3

Methods:

Patients who underwent knee arthroscopy for meniscal injury were prospectively enrolled between July 2011 and June 2019. Synovial fluid was aspirated and the concentrations of 10 biomarkers were measured by immunoassay. Smoking status, pack-years, and time since smoking cessation were collected. Log-normalized biomarker concentrations and smoking status were analyzed using analysis of variance (ANOVA) and linear regression.

Results:

A total of 297 patients (mean age, 45.7 ± 12.5 years; mean body mass index, 28.3 ± 5.3 kg/m 2 ; 55.6% male) were included. Patients were divided into current smokers (n = 27), former smokers (n = 54), and nonsmokers (n = 216). No descriptive differences between groups were found. ANOVA showed significant differences ( P < .01) in regulated on activation, normal T cell expressed and secreted (RANTES), monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1β, vascular endothelial growth factor, tissue inhibitors of metalloproteinases 1 and 2, interleukin-1 receptor antagonist (IL-1Ra), matrix metalloproteinase (MMP-3), and basic fibroblast growth factor (bFGF) between cohorts. Post hoc analysis revealed a significant difference between nonsmokers and former smokers for all biomarkers, aside from interleukin (IL)–6, that showed a significant difference on ANOVA testing. Significant differences were also found between smoker and nonsmoker cohorts for biomarkers MCP-1, MIP-1β, IL-1Ra, MMP-3, and bFGF. Linear regression analysis demonstrated a significant negative association between pack-years in the current smoker group and RANTES (β = −0.5115; P = .0358), and a positive association between time since quitting and IL-6 (β = 0.3842; P = .0084).

Conclusion:

Smoking status was found to be significantly associated with alterations in synovial fluid biomarker profiles in patients undergoing arthroscopic knee surgery for meniscal injury. RANTES was negatively associated with pack-years in current smokers, and IL-6 was positively associated with time since smoking cessation in former smokers. These findings suggest that smoking may have lasting effects on joint inflammation after injury, and that biomarker profiles can provide insight into local tissue responses influenced by smoking history.

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