ACL重建时口服避孕药使用可降低翻修手术风险。
简介
该研究基于TriNetX数据库纳入26,520例女性ACL重建患者，回顾性队列比较初次手术时是否口服避孕药（OCP）对同侧再手术率的影响。结果发现，OCP使用者5年内同侧ACL翻修风险降低25%，1年内关节粘连松解风险降低73%，且未显著增加静脉血栓栓塞风险。提示OCP可能作为降低高危女性ACL重建后翻修风险的辅助选择。
英文摘要
BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is associated with a significant risk of revision surgery. Oral contraceptive pills (OCPs) suppress endogenous estrogen and progesterone levels and have been associated with reducing the risk of primary ACL injuries in women. HYPOTHESIS: OCP use at the time of initial ACL reconstruction is associated with a reduced risk of subsequent ipsilateral procedures in female patients and an elevated risk of venous thromboembolism (VTE). STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A retrospective cohort study was conducted using the TriNetX database to compare female patients aged 13 to 49 years with and without documented OCP use at the time of initial ACL reconstruction. Cohorts were further stratified by time from reconstruction, age, body mass index, and diabetes status. Risk ratios with 95% CIs were calculated to evaluate the risk of subsequent ipsilateral procedures and VTE. RESULTS: Out of 26,520 patients who underwent ACL reconstruction, 1736 (6.5%) underwent subsequent ipsilateral ACL reconstruction within 5 years. Documented OCP users at the time of initial ACL reconstruction had a 25.0% lower risk of subsequent ipsilateral ACL reconstruction surgery within 5 years compared with nonusers (risk ratio [RR] = 0.750; P < 0.01). The protective effect was strongest in the first year (RR = 0.420; P < 0.01) and remained significant at 2 (RR = 0.471; P < 0.01), 3 (RR = 0.612; P < 0.01), and 4 years (RR = 0.600; P = 0.01). For loss-of-motion procedures, OCP use was associated with a 73% decreased risk within 1 year (RR = 0.269; P < 0.01). OCP use did not increase VTE risk significantly within 5 years (RR = 1.30; P = 0.10). CONCLUSION: OCP use at the time of initial ACL reconstruction in female patients was associated with a reduced risk of subsequent ipsilateral procedures, without increasing VTE risk. CLINICAL RELEVANCE: These findings highlight the potential of OCPs to reduce the physical and economic burden of revision in high-risk populations.