Injectable Testosterone Replacement Therapy Within 1 Year Before ACL Reconstruction Is Associated With Increased...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Endocrinology

Background:

• Exogenous testosterone use is linked to higher rates of tendinous rupture and systemic complications.
• Injectable testosterone replacement therapy (TRT) has known systemic risks.
• Limited research exists on the association between injectable TRT and anterior cruciate ligament reconstruction (ACLR) complications.

Purpose of the Study:

• To evaluate the association between preoperative injectable TRT and ACLR revision surgery.
• To determine if ACLR revision rates are higher in patients using TRT preoperatively compared to a matched cohort.

Main Methods:

• Retrospective cohort study of patients undergoing ACLR between 2015-2022.
• Identified patients with injectable TRT use before ACLR using ICD-10 and CPT codes.
• Propensity score matching was used to compare TRT users with a control group based on demographics and Charlson Comorbidity Index.

Main Results:

• Injectable TRT use within 1 year before primary ACLR was associated with a 17.05% revision rate versus 5.17% in the control group (Relative Risk: 3.30, P < .001).
• TRT use >1 year before surgery showed a trend towards increased revision risk (14.38% revision rate), though the analysis was underpowered.
• No significant difference in revision rates was observed for TRT users with any exposure (pre- or post-surgery) compared to controls (6.36% vs 6.21%, P = .82).

Conclusions:

• Preoperative injectable TRT use within one year of ACLR surgery is linked to a greater than threefold increase in ACLR revision rates.
• Physicians should counsel patients on the elevated risk of ACLR revision associated with recent TRT use.
• This information is crucial for shared decision-making in patients considering ACLR, especially those with a history of TRT use.