SEX-BASED DIFFERENCES IN ADULT ACL RECONSTRUCTION OUTCOMES
Purpose of review: In the setting of ever improving outcomes following anterior cruciate ligament (ACL) reconstruction, both objectively and subjectively, there remains continued interest in better understanding the differences in outcomes between male and female patients. The current review investigates the recent literature surrounding the roles of biological sex in adult ACL reconstruction outcomes.
Recent findings: Within the past five years, the most prominent and recurrent difference between male and female patient cohorts is the subjective report of pain and function. Female patients have been consistently shown to have worse self-reported outcomes following ACL reconstruction. Specific and quantifiable subjective outcomes that are highlighted include the International Knee Documentation Committee (IKDC) subjective score, the Knee injury and Osteoarthritis Outcome Score (KOOS), and patient-acceptable symptom state (PASS). Current research on the topic of biological sex-based differences in ACL reconstruction outcomes can be divided into four main categories: patient-reported subjective outcomes; physical assessment and gait analysis; kinematics; and rates of reinjury, revision, and contralateral reconstruction. This chapter provides a summary of recent literature focused on these four main areas of interest related to ACL reconstruction outcomes in males and females.
Fig 1 - ACL-RSI Scale
Conclusion: The purpose of this chapter was to review the evidence in recent literature of whether biological sex–based differences exist in surgical outcomes after primary ACL reconstruction. Current research on this topic was able to be divided into four main categories: patient-reported outcomes; physical assessment and gait analysis; kinematics and graft selection; and rates of reinjury, revision, and contralateral reconstruction. Based on the best-available evidence, the most consistent difference between male and female patients following ACLR is the subjective report of pain and function. Overall, female patients have been shown to have worse self-reported outcomes, increased risk of contralateral injury, and worse outcomes with hamstring grafts compared to BTB and quad tendon autograft. Future research to evaluate possible root causes to these differences, as well as create effective interventions, is required as we continue to improve ACLR surgical outcomes for all patients.
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Sex-Based Differences in Adult ACL Reconstruction Outcomes - PMC (nih.gov)
Published December 2022 in Current Reviews in Musculoskeletal Medicine.