Sex Differences in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction

Ageberg, Eva; Forssblad, Magnus; Herbertsson, Pär; Roos, Ewa M.

doi:10.1177/0363546510361218

Cited by 197 publications

(180 citation statements)

References 22 publications

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“…Despite the well-described role of sex on ACL injury risk, the role of sex on ACL injury treatment outcomes has been a topic of considerable debate with inconclusive findings [1,43,47,51]. The discrepancy in these results has been attributed mainly to the challenges associated with clinical studies of human cohorts, including relatively short followup and lack of outcome measures with sufficient sensitivity to detect sex-specific differences.…”

Section: Discussionmentioning

confidence: 99%

Validation of Porcine Knee as a Sex-specific Model to Study Human Anterior Cruciate Ligament Disorders

Kiapour

Shalvoy

Murray

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Animal models have long been considered an important modality for studying ACL injuries. However, to our knowledge, the value of these preclinical models to study sex-related phenomena associated with ACL injury and recovery has not been evaluated. Questions/purposesWe asked whether (1) prominent anatomic and (2) biomechanical factors differ between female and male porcine knees, particularly those known to increase the risk of ACL injury. Methods Eighteen intact minipig knees (nine males, nine females) underwent MRI to determine the femoral bicondylar width, intercondylar notch size (width, area and index), medial and lateral tibial slope, ACL size (length, cross-sectional area, and volume), and medial compartment tibiofemoral cartilage thickness. AP knee laxity at 30°, 60°, and 90°flexion and ACL tensile structural properties were measured using custom-designed loading fixtures in a universal tensile testing apparatus. Comparisons between males and females were performed for all anatomic and biomechanical measures. The findings then were compared with published data from human knees. Results Female pigs had smaller bicondylar widths (2.9 mm, ratio = 0.93, effect size = À1.5) and intercondylar notches (width: 2.0 mm, ratio = 0.79, effect size = À2.8; area: 30.8 mm 2 , ratio = 0.76, effect size = 2.1; index: 0.4, ratio = 0.84, effect size = À2.0), steeper lateral tibial slope (4.3°, ratio = 1.13, effect size = 1.1), smaller ACL (length: 2.7 mm, ratio = 0.91, effect size = 1.1; area: 6.8 mm 2 , ratio = 0.74, effect size = À1.5; volume: 266.2 mm 3 , ratio = 0.68, effect size = À1.5), thinner medial femoral cartilage (0.4 mm, ratio = 0.8, effect size = À1.1), lower ACL yield load (275 N, ratio = 0.81, effect size = À1.1), and greater AP knee laxity at 30°( 0.7 mm, ratio = 1.32, effect size = 1.1) and 90°(0.5 mm, ratio = 1.24, effect size = 1

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Section: Discussionmentioning

confidence: 99%

Validation of Porcine Knee as a Sex-specific Model to Study Human Anterior Cruciate Ligament Disorders

Kiapour

Shalvoy

Murray

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Some results based on data from the register have previously been published. 1,2 Similar registers exist in other countries, such as the Danish 3 and Norwegian registers, 4 as well as the Multicenter Orthopedic Outcomes Network study (MOON study). 5 In addition, databases like the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry (KPACLRR) 6 and the New York database 7 exist but without patient-reported outcomes.…”

Section: Introductionmentioning

confidence: 95%

Results From the Swedish National Anterior Cruciate Ligament Register

Kvist

Kartus

Karlsson

et al. 2014

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose: The purpose of the study was to report baseline variables and clinical outcome for almost 24,000 patients entered into the Swedish national ACL register. Methods:The register consists of two parts; one section in which surgeons report baseline and surgical data and one section in which patients report the Knee injury and Osteoarthritis Outcome Score (KOOS) and the EQ-5D before and one, two and five years after surgery.Results: By December 2012, 23,744 patients had been entered in the surgeons' part of the register. The female/male ratio in the register is 42/58. The mean age at primary ACL reconstruction was 26 (SD 11) and 28 (SD 9) years for the female and male patients respectively. The ACL injury occurred during soccer in 36% of the females and 49% of the males. In 2012, 95% of the primary ACL reconstructions were hamstring tendon autografts.For patients who had a minimum of five years of follow-up, the revision rate was 3.3% and the contralateral reconstruction rate was 3.8%. On all follow-up occasions up to five years, the patients who had undergone revision had a significantly (p<0.001) poorer outcome than those undergoing primary unilateral ACL reconstructions in all KOOS and EQ-5D dimensions.On all follow-up occasions, smokers obtained significantly poorer scores than non-smokers in terms of both the KOOS (p<0.008) and the EQ-5D scores (p<0.024). 3Conclusion: Soccer is the most common cause of injury in both females and males, patients undergoing revisions fare less well than those undergoing primary unilateral ACL reconstructions and smokers fare less well than non-smokers. The cumulative risk of an ACL revision or contralateral ACL reconstruction during a five-year period is approximately 7%.For patients under the age of 19 years, the cumulative risk is significantly higher.Level of Evidence: Level II, Lesser-quality prospective study 4

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“…The injury meniscus was the main concomitant lesion found in this study and has a prevalence of 41% to 82% [3], this may arise as a result of instability of the knee after the injury and may recur if the instability remains [18].…”

Section: Discussionmentioning

confidence: 65%

“…The higher prevalence of injuries in females is attributed to biomechanical and structural factors [4,8,15] that result in worse outcomes of injuries before ACL reconstruction surgery when compared to men [3].…”

Section: Discussionmentioning

confidence: 99%

“…The anterior cruciate ligament (ACL) is a major contributor to the stabilization of the knee [1] and so it's constantly injured [2], with an incidence of 0.8 cases per 1,000 inhabitants in individuals 10-64 years [3]. The rupture of this ligament commonly cause degeneration of other intrinsic knee structures as a consequence of post injury instability [4] and so articulate cartilage injuries are often encountered at the time of ACL reconstruction [5].…”

Section: Introductionmentioning

confidence: 99%

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Anterior Cruciate Ligament rupture and Concomitant Injuries

et al. 2015

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Introduction: The association between previous injury and the risk of re-injury has been widely studied, however still there are limited studies about the prevalence and distribution of the injuries associated to rupture of Anterior Cruciate Ligament (ACL) mainly focused on people who plays sports for leisure or to improve their quality of life.Objective: To identify the prevalence of concomitant injuries with rupture of ACL and its association with sex, age and practice of sports for leisure. Methods:Cross-sectional study of clinical base. It was analyzed the data of clinical records and demographic information of 807 individuals who underwent ACL reconstruction surgery in a clinic specializing in orthopedics knees in Santo André, São Paulo, Brazil. Results:The prevalence of concomitant injuries with the ACL injury was 57.9%. The meniscus injuries were the main concomitant injuries found. It is observed a trend of concomitant injuries with ACL rupture in males (59.2%) and in individuals who do not practice recreational sports (58.9%). Individuals who had concomitant lesions had higher median age (37%, 95% CI 36-39) compared to individuals diagnosed with isolated ACL rupture.

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Sex Differences in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction

Cited by 197 publications

References 22 publications

Validation of Porcine Knee as a Sex-specific Model to Study Human Anterior Cruciate Ligament Disorders

Validation of Porcine Knee as a Sex-specific Model to Study Human Anterior Cruciate Ligament Disorders

Results From the Swedish National Anterior Cruciate Ligament Register

Anterior Cruciate Ligament rupture and Concomitant Injuries

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