ArticleSports health2026
Testosterone and Anterior Cruciate Ligament Injury and Reconstruction Outcomes: A Systematic Review and Meta-analysis.
Article in Sports health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
9 authors.
Funding
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Abstract
contextTestosterone influences connective tissue biology, neuromuscular performance, and postoperative recovery. However, its clinical impact on anterior cruciate ligament (ACL) injury risk and outcomes after ACL reconstruction (ACLR) remains unclear.
objectiveTo evaluate the association between testosterone replacement therapy (TRT) or endogenous testosterone levels and ACL tear incidence, ACLR revision, patient-reported outcome measures (PROMs), strength, and complications. DATA SOURCES: Embase, Ovid MEDLINE, and PubMed were searched from inception to March 14, 2026. STUDY SELECTION: Studies evaluating TRT use or endogenous testosterone levels in relation to ACL tear incidence or outcomes after ACLR were included. Systematic reviews, narrative reviews, scoping reviews, letters, editorials, technical notes, conference abstracts without full-text publication, animal studies, cadaveric studies, case reports, and non-English studies were excluded. STUDY
designSystematic review and meta-analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Two reviewers independently extracted study characteristics, testosterone exposure, ACL tear incidence, ACLR revision, PROMs, strength outcomes, and complications. Random-effects meta-analyses pooled odds ratios for ACL tear incidence and ACLR revision. Study quality was assessed using the Methodological Index for Non-Randomized Studies and Cochrane Risk of Bias 2.0, and certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation.
resultsSeven studies were eligible, comprising 1,178,891 patients, of whom 589,436 were TRT users. TRT use was associated with a significantly increased risk of primary ACL tear within 2 years (odds ratio [OR], 2.83; 95% CI, 1.74-4.62;
conclusionTRT is associated with increased ACL tear risk at 2 years after initiation but does not appear to affect 2-year ACLR revision rates. Higher endogenous testosterone levels may influence ACL injury susceptibility in a sex-dependent manner, without impairing ACLR recovery.
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