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, P = .026), opioid prescriptions (52.7% vs 46.4%; OR 1.289, 95% CI 1.014‐1.637, P = .038), and clavicle fractures within both 90 days (19.6% vs 12.8%; OR 1.647, 95% CI 1.185‐2.294, P = .003) and 2 years (22.2% vs 16.0%; OR 1.493, 95% CI 1.098‐2.032, P = .010) postoperatively. Men had higher reported rates of loss of reduction within 90 days (14.2% vs 9.7%; OR 1.538, 95% CI 1.057‐2.237, P = .024), which was not significantly different within 2 years postoperatively. 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.