Loss of Reduction and Clavicle Fractures Commonly Occur in Patients Undergoing Acromioclavicular Joint Reconstruction and Female Sex Is Associated With Higher Fracture Risk.

Purpose: To use a large, multi-institutional database to characterize the outcomes and complication profile after primary acromioclavicular (AC) joint reconstruction and to evaluate potential sex-related differences in outcomes and complications. Methods: The TriNetX national database was queried for patients undergoing AC joint reconstruction between January 2015 and October 2022. Ninety-day and 2-year outcomes including shoulder-related complications, secondary surgeries, and medical resource use were evaluated. Propensity-matched analysis assessed the association between sex and these outcomes, reported as odds ratios (ORs) with 95% confidence intervals (CIs). A 2-year Kaplan-Meier analysis compared revision probability between men and women. Results: In patients undergoing primary AC joint reconstruction, the revision rate was 3.9%, with loss of reduction in 13.4% and distal clavicle fractures in 15.7% within 2 years of surgery. On sex-based analysis, women had higher reported rates of postoperative antidepressant use (15.8% vs 11.2%; OR 1.495, 95% CI 1.048-2.132, Conclusions: After primary AC joint reconstruction, loss of reduction (2 years, 13.4%) and distal clavicle fractures (2 years, 15.7%) were frequently reported complications in the postoperative period, with a 3.9% revision reconstruction rate within 2 years. Women reported higher rates of distal clavicle fracture in the postoperative period, and the high fracture rate in the female cohort (90 days, 19.6%) highlights a potentially under-recognized clinical consideration. Level of Evidence: Level III, retrospective cohort study.