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Sex-Specific Outcomes in Adolescent ACL Reconstruction: A Propensity-Matched Cohort Study
Ali Rteil1, Rebecca Luft2, Jason Koh1
1Department of Orthopaedic Surgery, Endeavor Health, an Affiliate of the University of Chicago Pritzker School of Medicine, Skokie, Illinois, USA.
Orthopaedic Journal of Sports Medicine
|May 15, 2026
Summary
Female adolescents undergoing anterior cruciate ligament reconstruction (ACLR) face higher rates of postoperative stiffness, requiring manipulation under anesthesia. Male adolescents utilized rehabilitation more frequently, but revision ACLR rates were similar between sexes.
Area of Science:
- Orthopedic surgery
- Sports medicine
- Adolescent health
Background:
- Sex-related differences in adolescent anterior cruciate ligament reconstruction (ACLR) outcomes are not well-understood.
- Existing research shows inconsistent findings on sex-based differences in specific postoperative complications.
Purpose of the Study:
- To investigate sex-specific differences in postoperative complications following adolescent ACLR.
- Utilized a multicenter cohort with propensity matching and a 2-year follow-up period.
Main Methods:
- Retrospective data analysis from the TriNetX Research Network.
- Propensity score matching (1:1) for 7793 male and female adolescents (ages 12-19) undergoing ACLR.
- Compared outcomes including revision ACLR, meniscal surgery, and other complications at 3, 6, 12 months, and 2 years.
Main Results:
- Female adolescents had higher rates of manipulation under anesthesia (MUA) and lysis of adhesions at 6 months, 1 year, and 2 years post-ACLR.
- Male adolescents showed higher rehabilitation utilization at 3 and 6 months.
- No significant sex-based differences were found in subsequent ACLR revision or meniscal surgery rates.
Conclusions:
- Adolescent ACLR patients exhibit distinct postoperative complication profiles based on sex.
- Female patients are more prone to postoperative stiffness, necessitating procedures like MUA.
- Postoperative stiffness should be considered a sex-specific complication in adolescents, informing future research and clinical monitoring.
