Prescription Testosterone Is Associated With an Increased Risk of Anterior Cruciate Ligament Injury.

TRT was associated with a significantly higher incidence of ACL injuries compared to controls.

• Incidence of ACL injuries was 17.8 per 10,000 person-years (95% CI: 16.4-19.2) for TRT patients versus 4.9 per 10,000 person-years (95% CI: 4.1-5.7) for controls (P < .001).
• Within 2 years, 572 (0.35%) TRT patients experienced an ACL injury compared to 157 (0.10%) controls.
• Odds ratio for ACL injury in TRT patients was 2.77 (95% CI: 2.26-3.42, P < .001).
• After matching, there were 160,839 patients in both the TRT cohort and the control cohort.
• TRT was required for at least 3 months before inclusion; follow-up period was 2 years.

When stratified by age, nearly all age groups showed a significantly higher rate of ACL tears in TRT patients.

• All age groups except the under-25 years group demonstrated a significantly higher rate of ACL tears.
• Odds ratios ranged from 3.91 to 12.3 across the significant age subgroups (P < .001 to .009).
• Age subgroups examined were: <25, 25-35, 36-45, 46-55, 56-65, and 65+ years.
• The <25 years age group did not demonstrate a statistically significant difference in ACL tear rates.

Both males and females on TRT had significantly higher odds of ACL injury compared to controls.

• Males on TRT were 3.13 (95% CI: 2.50-3.93, P < .001) times more likely to experience an ACL injury compared to controls.
• Females on TRT were 1.94 (95% CI: 1.13-3.41, P = .018) times more likely to experience an ACL injury compared to controls.
• The association was statistically significant for both sexes, though the odds ratio was higher for males than females.

The study used a retrospective cohort design with propensity-matched controls drawn from a large insurance database.

• This was a retrospective cohort study using a large insurance database.
• Patients prescribed TRT for at least 3 months were matched with controls who were not prescribed TRT.
• Multivariable logistic regressions were performed to determine the association of TRT with ACL tears while accounting for demographic variables and comorbidities.
• The study was classified as Level III evidence, retrospective comparative study.