Effects of Cigarette Smoking on Elastographic Strain Ratio Measurements of Patellar and Achilles Tendons

Ağladıoğlu, Kadir; Akkaya, Nuray; Gungor, Harun R.; Akkaya, Semih; Ök, Nusret; Özçakar, Levent

doi:10.7863/ultra.15.11050

Cited by 32 publications

(25 citation statements)

References 29 publications

(61 reference statements)

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“…Nicotine's vasoconstrictive properties are well known and our ultrasound data confirms that nicotine hinders blood flow in tendons. Furthermore, our biomechanical data reveal that nicotine leads to decreased cross sectional area of the injured tendon (i.e., less scar formation at the injury site), in concordance with previous literature . Data suggest that nicotine results in less hypertrophic scar and keloid formation, as well as decreased proliferation of myofibroblasts in post‐surgical scars .…”

Section: Discussionsupporting

confidence: 91%

Nicotine impairs intra‐substance tendon healing after full thickness injury in a rat model

Cheema

Newton

Boorman-Padgett

et al. 2018

Journal Orthopaedic Research

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Nicotine is harmful to many bodily systems; however, the effects of nicotine on intra-substance tendon healing remain largely unexplored. The purpose of this study was to examine the functional, structural, and biomechanical effects of nicotine on the healing of Achilles tendons in rats after an acute full-thickness injury. Sixty Sprague-Dawley rats were enrolled in this study. Half were exposed to 0.9% saline and half to 61ng/mL of nicotine for 3 months via subcutaneous osmotic pumps. At 3 months, all rats underwent blunt full thickness transection of the left Achilles tendon and were immobilized for one week in plantarflexion. In-vivo assays were conducted prior to injury, at 21 days, and at 42 days post-injury and included the following: functional limb assessment, passive joint mechanics, and vascular evaluation. Rats were sacrificed at 21 and 42 days for biomechanical testing and histologic evaluation. Rats exposed to nicotine demonstrated decreased vascularity, greater alteration in gait mechanics, and increased passive ROM of the ankle joint. Biomechanically, the nicotine tendons failed at lower maximum loads, were less stiff, had smaller cross-sectional areas and had altered viscoelastic properties. Histologically, nicotine tendons demonstrated decreased vessel density at the injury site.

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Section: Discussionsupporting

confidence: 91%

Nicotine impairs intra‐substance tendon healing after full thickness injury in a rat model

Cheema

Newton

Boorman-Padgett

et al. 2018

Journal Orthopaedic Research

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“…9 Furthermore, in a clinical study that analyzed the Achilles tendon with ultrasonography, it was found that smoking was associated with a thinner tendon and increased strain ratio. 1 In our study, we did not detect a difference in AT or SS CSA, which may explain why we did not observe changes in modulus that was observed in these previous studies. Furthermore, our rats received a dose of nicotine equivalent to the average American smoker (14 cigarettes per day) where the previous studies had nicotine doses for heavy smoker (>20 cigarettes per day).…”

Section: Discussioncontrasting

confidence: 61%

Chronic Nicotine Exposure Alters Uninjured Tendon Vascularity and Viscoelasticity

Gittings

Riggin

Boorman-Padgett

et al. 2019

Foot & Ankle Orthopaedics

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Background: Although nicotine and tobacco use are well established to have adverse health effects, the effects on tendons are less well understood. The purpose of this study was to investigate the effect of chronic nicotine exposure on Achilles tendon (AT) and supraspinatus tendon (SS) physiologic and mechanical properties in a rodent model. Methods: Sprague-Dawley rats (n ¼ 20) were exposed to either 0.9% saline or 36 mg/mL nicotine through an implantable osmotic pump for 12 weeks. At 12 weeks, the AT was imaged in vivo with contrast-enhanced ultrasound (CE-US) to assess vascularity. Bilateral AT and SS were then harvested for ex vivo biomechanical analysis. Statistical analysis was performed using Student t test and Mann Whitney U test. Results: AT CE-US demonstrated a significantly increased wash-in rate in the nicotine group compared to the saline group, indicating an increase in tissue perfusion rate in the nicotine group. AT percent stress relaxation, a measure of tendon viscoelasticity, was significantly increased in the nicotine group compared to the saline group. Similarly, there was a trend toward increased SS percent stress relaxation in the nicotine group compared to the saline group. No differences in other mechanical properties were observed. Conclusion: AT perfusion rate increased and both AT and SS viscoelasticity were altered with chronic nicotine exposure at a clinically relevant dose that models the average smoker in the United States (14 cigarettes per day). Further studies are necessary to link these properties with tendon degeneration and injury. Clinical Relevance: Chronic nicotine exposure affects tendon health. Patients should be counseled as such.

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“…The retrospective cohort study in patients with calcified calcific tendinitis of the rotator cuff found smoking was significantly associated with a failure of needle aspiration of calcific deposits (n ACD) (adjusted OR = 1.7, 95% CI: 1.0-2.7, P = 0.04) [ 246 ]. One case-control study reported smokers had significantly thinner patellar and Achilles tendons in the proximal, middle, and distal thirds region of the tendons and significant lower strain ratio measurements in the same regions (P < 0.05); pack-years were inversely related to patellar tendon thickness (P < 0.05) [ 241 ]. One cross-sectional study reported smokers had significant improvement in finger range of motion over nonsmokers after tendon grafting [ 243 ].…”

Section: Resultsmentioning

confidence: 99%

The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review

Al-Bashaireh

Haddad

Weaver

et al. 2018

Journal of Environmental and Public Health

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This systematic review explored associations between smoking and health outcomes involving the musculoskeletal system. AMSTAR criteria were followed. A comprehensive search of PubMed, Web of Science, and Science Direct returned 243 articles meeting inclusion criteria. A majority of studies found smoking has negative effects on the musculoskeletal system. In research on bones, smoking was associated with lower BMD, increased fracture risk, periodontitis, alveolar bone loss, and dental implant failure. In research on joints, smoking was associated with increased joint disease activity, poor functional outcomes, and poor therapeutic response. There was also evidence of adverse effects on muscles, tendons, cartilage, and ligaments. There were few studies on the musculoskeletal health outcomes of secondhand smoke, smoking cessation, or other modes of smoking, such as waterpipes or electronic cigarettes. This review found evidence that suggests tobacco smoking has negative effects on the health outcomes of the musculoskeletal system. There is a need for further research to understand mechanisms of action for the effects of smoking on the musculoskeletal system and to increase awareness of healthcare providers and community members of the adverse effects of smoking on the musculoskeletal system.

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Effects of Cigarette Smoking on Elastographic Strain Ratio Measurements of Patellar and Achilles Tendons

Abstract: Thickness and strain ratio measurements of patellar and Achilles tendons were reduced (thinner and harder tendons) in smokers. Clinical implications of these morphologic and elastographic changes should be investigated in future studies.

Cited by 32 publications

References 29 publications

Nicotine impairs intra‐substance tendon healing after full thickness injury in a rat model

Nicotine impairs intra‐substance tendon healing after full thickness injury in a rat model

Chronic Nicotine Exposure Alters Uninjured Tendon Vascularity and Viscoelasticity

The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review

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