Poster 19. Adolescent ACL Reconstruction Outcomes Differ by Sex: A Three-Year Propensity-Matched Cohort Analysis
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective: Sex-specific outcomes following anterior cruciate ligament reconstruction (ACLR) in adolescents remain inadequately defined. Previous studies suggest that females may be at a higher risk of postoperative stiffness, whereas males may be more susceptible to infections or complications related to grafts. Nonetheless, these investigations have mainly been constrained by small sample sizes and data sourced from a single institution. The objective of this study was to utilize a national database to assess sex-related differences in both short- and long-term complications associated with ACLR in the adolescent population. Methods: A retrospective cohort study was performed using the TriNetX Research Network. Adolescents aged 12 to 19 years who underwent ACLR were identified by ICD-10 and CPT codes. Male and female cohorts were propensity score-matched 1:1 for age, body mass index, tobacco use, diabetes, depression, and other relevant comorbidities. Outcomes of interest included knee stiffness, secondary procedures (manipulation under anesthesia and lysis of adhesions), meniscal tears, revision ACLR, infection, thromboembolic events, and hospital readmissions. Events were assessed at 3, 6, and 12 months, as well as 3 years postoperatively. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results: The initial cohort included 7,082 males and 8,017 females. Following 1:1 propensity score matching, 5,942 patients remained in each group with a mean age of 16.2 ± 1.7 years. At 3 months, females exhibited higher odds of manipulation under anesthesia (0.5 vs. 0.2%; OR 0.32, P<0.001) and lysis of adhesions (0.4 vs. 0.2%; OR 0.42, P=0.02), whereas males had greater odds of meniscal tears (20.8 vs. 17.7%; OR 1.22, P<0.001). At 6 months, males continued to demonstrate higher rates of meniscal tears (23.4 vs. 20.1%; P<0.001), while females were more likely to develop knee stiffness (7.7 vs. 6.5%; OR 0.84, P=0.02) and to undergo manipulation under anesthesia (0.7 vs. 0.2%; P<0.001) and lysis of adhesions (1.4 vs. 0.4%; P<0.001) (Table 1).At the 12-month mark, female patients exhibited a significantly increased risk of experiencing stiffness and lysis of adhesions, with statistical significance confirmed across all measures (P < 0.001). In contrast, male patients were more likely to require ACLR revision, as indicated by an odds ratio of 1.34 (P < 0.001). By the time the study reached the 3-year follow-up, these distinct sex-specific trends remained evident. Females continued to show persistently elevated rates of stiffness and a greater need for secondary interventions. At the same time, males sustained higher frequencies of meniscal tears and revision surgeries, as detailed in Table 1. Conclusions: In this comprehensive, propensity-matched national analysis, distinct complication profiles were observed following anterior cruciate ligament reconstruction (ACLR) in adolescent males and females. Females exhibited consistently higher rates of postoperative stiffness and required subsequent procedures, whereas males faced an increased risk of meniscal tears and revision reconstructions. These persistent patterns emphasize the significance of sex as a critical factor influencing recovery outcomes. Such findings may inform perioperative counseling, facilitate the development of individualized rehabilitation strategies, and guide future research aimed at elucidating the mechanisms underlying these observed disparities.
Authors: Farid Amirouche, Ali Rteil, Rebecca Luft, Jason Koh
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W7204816403