Purpose
To evaluate the biomechanical and histologic effects on Achilles tendon repair of
inhaled combusted tobacco versus nicotine exposure via electronic cigarette versus
a control group in a small-animal model (Sprague-Dawley rat).
Methods
Fifty-four Sprague-Dawley rats were randomized into 3 groups: combusted tobacco, e-cigarettes,
or control. Experimental rats were exposed to research cigarettes or e-cigarette vapor
in a smoking chamber for 4 weeks. Surgical transection and repair of the Achilles
tendon were then completed, followed by 2 additional weeks of exposure. Achilles tendons
were harvested, and biomechanical tensile testing was performed. Histologic evaluation
was completed, including hematoxylin-eosin staining, trichrome staining, and immunohistochemistry
analysis for type I and type III collagen.
Results
The control group showed the highest mean tensile load to failure, at 41.0 ± 10.4
N (range, 18.3-55.1 N); the cigarette cohort had the second highest mean, at 37.3
± 11.1 N (range, 14.0-54.7 N); and finally, the vaping group had the lowest mean,
at 32.3 ± 8.4 N (range, 17.8-45.1 N). One-way analysis of variance showed a significant
difference in load to failure when comparing the control group with the e-cigarette
group (P = .026). No statistical difference was detected between the control group and cigarette
group (P = .35) or between the e-cigarette group and cigarette group (P = .23). Stiffness and qualitative histologic analysis showed no difference among
groups.
Conclusions
This investigation shows that in a rat model, nicotine exposure via e-cigarette significantly
impedes the biomechanical healing properties of Achilles tendon surgical repair.
Clinical Relevance
The results indicate that although e-cigarettes are often used as a perceived “safer”
alternative to smoking, their use may have a detrimental effect on tendon load to
failure.
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Article Info
Publication History
Published online: April 30, 2021
Accepted:
March 30,
2021
Received:
July 23,
2020
Footnotes
The authors report the following potential conflicts of interest or sources of funding: M.A. is a consultant for Stryker and Arthrex, outside the submitted work; receives a research grant from Arthrex, outside the submitted work; and is a committee member of American Orthopaedic Foot & Ankle Society Research Committee. M.G. receives research support from DePuy Synthes and Orthopaedic Trauma Association; receives consulting fees from DePuy Synthes; and owns stock options in ROM 3 Rehab, outside the submitted work. A.D. is a consultant for Smith & Nephew, Arthrex, and Avenue Therapeutics and receives grant support from Smith & Nephew, U.S. Department of Defense, National Institutes of Health, Penn State University, and Revotek, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2021 by the Arthroscopy Association of North America
