Short-Term Postoperative Risks Associated With Contraceptive Use Prior to ACL Reconstruction in Female Patients

Objectives: The purpose of this study was to evaluate whether preoperative hormonal contraceptive use is associated with increased short-term surgical complications and lifetime risk of osteoarthritis following anterior cruciate ligament (ACL) reconstruction in female patients. Methods: A retrospective cohort study was conducted utilizing the Research Network on the TriNetX database. Female patients who underwent an ACL reconstruction were identified and categorized into two subgroups: those prescribed hormonal contraceptives (ethinyl estradiol & etonogestrel) prior the index surgery (n=6,455), and those who were not (n=37,169). Following 1:1 propensity score matching for age, ethnicity, gender, body mass index, hypertension, diabetes mellitus, and nicotine dependence, 6,386 patients remained in each cohort. Short-term outcomes (90 days) included 90-day risk of surgery site infection (SSI), pulmonary embolism (PE), deep vein thrombosis (DVT), myocardial infarction, urinary tract infection (UTI), opioid-related disorders, hospital readmission, emergency department utilization, stroke, knee stiffness, ACL reinjury or graft failure. All postoperative complications were analyzed using risk ratios (RR), with statistical significance set to p<0.05. Results: Patients prescribed hormonal contraceptives prior to ACL reconstruction had a significantly increased 90-day risk several complications including pulmonary embolism (RR=2.100, p=0.048), DVT (RR=1.692, p=0.031), UTI (RR=1.800, p=0.005), emergency department utilization (RR=1.207, p=0.039), knee stiffness/ankylosis (RR=1.323, p<0.001), and ACL reinjury (RR=1.391, p<0.001) compared with those who did not receive contraceptives. Other outcomes analyzed had no statistically significant difference. Conclusions: Use of preoperative hormonal contraceptives was associated with an increased risk of complications following ACL reconstruction. Though many different factors can contribute to postoperative complications, surgeons may use this information to better inform appropriate patients regarding the risks of surgery.