Age, female sex, and oral contraceptive use are risk factors for anterior cruciate ligament reconstruction: A nationwide database study

• Published in: The knee Vol. 40; pp. 135 - 142
• Main Authors: Wang, Cindy X., Kale, Nisha, Wu, Victor J., Stamm, Michaela, Mulcahey, Mary K.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2023
• Subjects: ACL reconstruction; Adolescent; Adult; Anterior Cruciate Ligament Injuries - complications; Anterior Cruciate Ligament Injuries - epidemiology; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - adverse effects; Athletes; Contraceptives, Oral - adverse effects; Female; Females; Humans; Male; Males; Obesity - complications; Obesity - epidemiology; Oral contraceptive pills; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Risk Factors; Young Adult; Young age; Young age; Oral contraceptive pills; ACL reconstruction; Females; Males; Athletes
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2022.11.011

The purpose of this study was to investigate risk factors affecting anterior cruciate ligament (ACL) tears and outcomes following ACL reconstruction in males versus females. This study also analyzed oral contraceptive pill (OCP) use, demographics (e.g., body mass index [BMI], age group), comorbidities (e.g., diabetes, hypertension), and post-operative systemic complications (e.g., anemia, malignant hyperthermia) in patients undergoing ACL reconstruction. Medical records of patients undergoing ACL reconstruction from 2010–2018 were queried from the PearlDiver administrative claims database current procedural terminology (CPT) and international classification of disease (ICD) codes. The following information was collected using ICD-9/ICD-10 codes: concurrent use of OCPs, concomitant meniscus repair, demographics, age, comorbidities, and systemic complications. The number of ACL reconstructions in females and males were analyzed using multivariate regressions. Of 11,498 ACL reconstructions, 5,967 (51.9%) were in females and 5,531 (48.1%) were in males. The majority of patients were ages 15–19 (24.1%) and were not obese (BMI < 30 kg/m2) (35.9%). A greater proportion of female patients undergoing ACL reconstruction were between 15–19 years old (P < 0.001) and obese (BMI > 40 kg/m2) (P < 0.001). A larger proportion of females aged 15–39 taking OCPs underwent ACL reconstruction compared to those not taking OCPs within the same age group (P < 0.001). ACL tears are more common in female patients compared to males and are more commonly treated with ACL reconstruction. This study identified several factors that may be associated with the increased risk of ACL tears in females, including young age (age 15–39), obesity (BMI > 40 kg/m2), and the use of OCPs prior to ACL reconstruction, which warrant further investigation and attention from surgeons.