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

It has been demonstrated that exogenous testosterone can lead to higher rates of tendinous rupture and that injectable testosterone replacement therapy (TRT) is associated with more systemic complications. While this is the case, there are few studies exploring associations between injectable TRT and complications after anterior cruciate ligament reconstruction (ACLR) surgery.

The purpose of this study is to evaluate the association between preoperative injectable TRT and ACLR revision surgery. It was hypothesize that ACLR revision surgery rates will be higher in patients undergoing TRT preoperatively compared with a matched cohort.

Cohort study; Level of evidence, 3.

A retrospective cohort of patients who underwent ACLR between 2015 and 2022 was obtained through the PearlDiver Database (Mariner). Patients with a history of ACLR, 2 years of follow-up, and injectable TRT use before ACLR were identified using International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes. Three TRT usage intervals were analyzed to evaluate ACLR revision rates in those with usage of injectable TRT compared with those with propensity score-matched demographics and Charlson Comorbidity Index with no history of injectable TRT use who underwent ACLR. Cohorts were via univariate analysis, chi-square tests, Student t tests, and log-rank tests.

TRT use ≤1 year before primary ACLR surgery demonstrated a 17.05% (66/387; mean age, 40.3) ACLR revision rate compared with 5.17% (20/387; mean age, 40.8) in the matched cohort control group (P < .001), yielding a relative risk of revision surgery of 3.30 (95% CI, 2.04-5.33). Statistical analysis for distant TRT use >1 year before surgery (n = 160) was underpowered but supported trends toward increased revision risk with TRT exposure with a 14.38% revision rate (n = 23). TRT users with any exposure before or after surgery (n = 2614) had similar revision rates (n = 168; 6.36%) compared with the control group (n = 164; 6.21%); the difference was not significant (P = .82).

Our study demonstrated that injectable TRT use within 1 year of primary ACLR is associated with a >3-fold increase in ACLR revision rates with 2 years of follow-up. Physicians should consider incorporating this increased risk into patient counseling during shared decision-making discussions, as this correlation may influence clinical and surgical decision making for patients with previous ACLR.