Timing of Isotretinoin Exposure and Early Postoperative Complications after Anterior Cruciate Ligament Reconstruction

Isotretinoin (ITN) is widely prescribed for severe acne in adolescents and young adults, a population where anterior cruciate ligament reconstruction (ACLR) is commonly performed. Long-standing concerns about impaired wound healing have prompted many surgeons to delay procedures, despite limited orthopaedic-specific evidence. This retrospective case series evaluates early postoperative clinical complications in patients with documented ITN exposure undergoing ACLR.

We retrospectively reviewed primary ACLR cases from 2015 to 2025 at a multisite orthopaedic practice with documented ITN exposure within 12 months of surgery and at least 3 months of follow-up. ITN exposure was categorized as perioperative (≤10 days), recent (>10 days to 6 months), or remote (>6 to 12 months). The primary outcome was noninfectious incision-site wound complications. Secondary outcomes included graft-site and surgical complications.

Fifty-nine patients (53% female; mean age 18 ± 5 years; BMI 23 ± 2.9 kg/m2, mean follow-up, 9.3 ± 3.3 months) who underwent autograft ACLR were included. Noninfectious wound complications occurred in three patients (5.1%): two remote exposures (incisional bleeding and hemorrhagic bulla) and one recent exposure (contact dermatitis). One graft-site complication (mini cyclops lesion with associated infrapatellar fat-pad scarring) and five surgical complications (postoperative arthrofibrosis requiring revision surgery) were identified. All wound complications resolved conservatively, and no surgical site infections occurred.

This retrospective case series observed a low incidence of noninfectious wound, graft-site, and surgical complications among ITN-exposed patients undergoing ACLR. These findings are hypothesis generating and underscore the need for adequately powered comparative studies to clarify the impact of ITN exposure timing on postoperative healing in orthopaedic surgery.