Five-year Outcomes Following Anterior Cruciate Ligament Reconstruction: Does Sex Impact Patient-Reported Outcomes and Re-operation Rates?
DOI:
https://doi.org/10.53646/bsgh0y62Keywords:
ACL reconstruction, sex-based outcomes, orthopedic, sports medicine, patient reported outcomes, female athelteAbstract
BACKGROUND: Females have been shown to have a two to eight times higher risk of Anterior Cruciate Ligament (ACL) injury than their male counterparts. Despite the clear difference in risk, sex-based differences in outcomes following ACL reconstruction are less well understood.
The purpose of this study was to compare 5-year outcomes between males and females who were under the age of 26 at the time of enrollment in an ACL registry. We hypothesize that male and female patients will have similar patient-reported outcome scores, but females will have a higher incidence of ACL graft re-injury.
METHODS: Patients undergoing ACL reconstruction while under the age of 26 were included if they also had completed five-year follow-up questionnaires. Outcomes were compared between males and females, and the outcomes of interest included the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Score (KOOS), ACL Return to Sport after Injury (ACL-RSI), and reoperation.
RESULTS: Of the 159 patients enrolled in the registry, 35 had complete follow-up (22%). The average difference between postoperative and preoperative IKDC scores for males and females was 37.9 ± 21.6 and 33.2 ± 26.6, respectively (p=.600). The average difference between postoperative and preoperative KOOS scores for males and females was 31.6 ± 15.4 and 29.2 ± 23.0, respectively (p=0.731). The average ACL-RSI for males and females was 79.8 ± 47.0 and 56.5 ± 31.1, respectively (p=0.088). The incidence of reoperation and ACL re-tear for the entire cohort was 28.6% and 5.7%, respectively.
CONCLUSION: Overall, males and females under the age of 26 who underwent ACLR had similar 5-year outcomes regarding outcomes scores after surgical intervention. The ACL-RSI was lower in women, however, failed to reach significance. The reoperation rate for males and females was not statistically significant. ACL reconstruction is a successful operation in young males and females with improvement in knee outcome scores and ability to return to sport.
References
1. Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE. Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. J Orthop Res. 2016;34(11):1843-1855.
2. Schilaty ND, Nagelli C, Bates NA, et al. Incidence of Second Anterior Cruciate Ligament Tears and Identification of Associated Risk Factors From 2001 to 2010 Using a Geographic Database. Orthop J Sports Med. 2017;5(8):2325967117724196.
3. Mall NA, Chalmers PN, Moric M, et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42(10):2363-2370.
4. Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med. 1995;23(6):694-701.
5. Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train. 1999;34(2):86-92.
6. Gwinn DE, Wilckens JH, McDevitt ER, Ross G, Kao TC. The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy. Am J Sports Med. 2000;28(1):98-102.
7. Noojin FK, Barrett GR, Hartzog CW, Nash CR. Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women. Am J Sports Med. 2000;28(6):783-789.
8. Ageberg E, Forssblad M, Herbertsson P, Roos EM. Sex differences in patient-reported outcomes after anterior cruciate ligament reconstruction: data from the Swedish knee ligament register. Am J Sports Med. 2010;38(7):1334-1342.
9. Ryan J, Magnussen RA, Cox CL, Hurbanek JG, Flanigan DC, Kaeding CC. ACL reconstruction: do outcomes differ by sex? A systematic review. J Bone Joint Surg Am. 2014;96(6):507-512.
10. Mok AC, Fancher AJ, Vopat ML, et al. Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2022;10(2):23259671221076883.
11. Kaeding CC, Pedroza AD, Reinke EK, et al. Risk Factors and Predictors of Subsequent ACL Injury in Either Knee After ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions From the MOON Cohort. The American Journal of Sports Medicine. 2015;43(7):1583-1590.
12. Paterno MV, Huang B, Thomas S, Hewett TE, Schmitt LC. Clinical Factors That Predict a Second ACL Injury After ACL Reconstruction and Return to Sport: Preliminary Development of a Clinical Decision Algorithm. Orthop J Sports Med. 2017;5(12):2325967117745279.
13. Webster KE, Feller JA, Leigh WB, Richmond AK. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42(3):641-647.
14. Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008;9(1):9-15.
15. Muller B, Yabroudi MA, Lynch A, et al. Defining Thresholds for the Patient Acceptable Symptom State for the IKDC Subjective Knee Form and KOOS for Patients Who Underwent ACL Reconstruction. Am J Sports Med. 2016;44(11):2820-2826.
16. Tan SH, Lau BP, Khin LW, Lingaraj K. The Importance of Patient Sex in the Outcomes of Anterior Cruciate Ligament Reconstructions: A Systematic Review and Meta-analysis. Am J Sports Med. 2016;44(1):242-254.
17. Thaunat M, Clowez G, Saithna A, et al. Reoperation Rates After Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction: A Series of 548 Patients From the SANTI Study Group With a Minimum Follow-up of 2 Years. Am J Sports Med. 2017;45(11):2569-2577.
18. Ponce BA, Cain EL, Jr., Pflugner R, et al. Risk Factors for Revision Anterior Cruciate Ligament Reconstruction. J Knee Surg. 2016;29(4):329-336.
19. Rahardja R, Zhu M, Love H, Clatworthy MG, Monk AP, Young SW. Rates of revision and surgeon-reported graft rupture following ACL reconstruction: early results from the New Zealand ACL Registry. Knee Surg Sports Traumatol Arthrosc. 2020;28(7):2194-2202.
20. Schlumberger M, Schuster P, Schulz M, et al. Traumatic graft rupture after primary and revision anterior cruciate ligament reconstruction: retrospective analysis of incidence and risk factors in 2915 cases. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):1535-1541.
21. Webster KE, Feller JA. Exploring the High Reinjury Rate in Younger Patients Undergoing Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2016;44(11):2827-2832.
22. Spindler KP, Huston LJ, Chagin KM, et al. Ten-Year Outcomes and Risk Factors After Anterior Cruciate Ligament Reconstruction: A MOON Longitudinal Prospective Cohort Study. Am J Sports Med. 2018;46(4):815-825.
23. Cristiani R, Mikkelsen C, Edman G, Forssblad M, Engström B, Stålman A. Age, gender, quadriceps strength and hop test performance are the most important factors affecting the achievement of a patient-acceptable symptom state after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2020;28(2):369-380.
24. Milewski MD, Traver JL, Coene RP, et al. Effect of Age and Sex on Psychological Readiness and Patient-
Reported Outcomes 6 Months After Primary ACL Reconstruction. Orthop J Sports Med. 2023;11(6):23259671231166012.
25. Christino MA, Fantry AJ, Vopat BG. Psychological Aspects of Recovery Following Anterior Cruciate Ligament Reconstruction. J Am Acad Orthop Surg. 2015;23(8):501-509.
26. Little RM, Milewski MD. Physeal fractures about the knee. Curr Rev Musculoskelet Med. 2016;9(4):478-486.
27. Su AW, Larson AN. Pediatric Ankle Fractures: Concepts and Treatment Principles. Foot Ankle Clin. 2015;20(4):705-719.
28. Kaplan Y, Witvrouw E. When Is It Safe to Return to Sport After ACL Reconstruction? Reviewing the Criteria. Sports Health. 2019;11(4):301-305.
29. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41(7):1549-1558.
30. Snaebjörnsson T, Svantesson E, Sundemo D, et al. Young age and high BMI are predictors of early revision surgery after primary anterior cruciate ligament reconstruction: a cohort study from the Swedish and Norwegian knee ligament registries based on 30,747 patients. Knee Surg Sports Traumatol Arthrosc. 2019;27(11):3583-3591.
31. Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med. 2012;22(2):116-121.
32. Webster KE, Hewett TE, Feller JA. Anterior Cruciate Ligament Injuries in Australian Rules Football: Incidence, Prevention and Return to Play Outcomes. Open Access J Sports Med. 2021;12:33-41.
33. Kaeding CC, Aros B, Pedroza A, et al. Allograft Versus Autograft Anterior Cruciate Ligament Reconstruction: Predictors of Failure From a MOON Prospective Longitudinal Cohort. Sports Health. 2011;3(1):73-81.
34. Nester JR, Torino D, Sylvestre D, et al. Risk of reoperation after primary anterior cruciate ligament reconstruction in children and adolescents. J Orthop Surg (Hong Kong). 2022;30(2):10225536221122340.
35. Soneru A, Sarwark JF. Survivorship of allograft ACL reconstruction in adolescent patients. J Orthop. 2019;16(1):11-13.
36. Engelman GH, Carry PM, Hitt KG, Polousky JD, Vidal AF. Comparison of allograft versus autograft anterior cruciate ligament reconstruction graft survival in an active adolescent cohort. Am J Sports Med. 2014;42(10):2311-2318.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Journal of Women's Sports Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.