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Ebert, Jay R.; Calvert, Nicholas D.; Radic, Ross
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 08/2024Journal Article
Abstract Purpose To investigate sex‐based recovery differences in patients undergoing anterior cruciate ligament reconstruction (ACLR) with a hamstring (HT) or quadriceps (QT) tendon autograft. Methods This study included 97 patients, including 50 females (HT = 25, QT = 25) and 47 males (HT = 24, QT = 23), assessed presurgery and at 12‐ and 24‐month postoperatively via surveys, laxity, isokinetic knee extensor and flexor torque and a 6‐hop performance battery. Limb symmetry indices (LSIs) were calculated. Outcomes were compared between males and females, as well as within each graft type. Results Males reported significantly higher Tegner scores at 12 ( p = 0.029) and 24 ( p = 0.031) months, Anterior Cruciate Ligament Return to Sport after Injury scores at 12 ( p = 0.009) and 24 ( p = 0.010) months, and a significantly higher lateral hop LSI at 12 ( p = 0.045) months, knee extensor torque LSI at 12 ( p = 0.020) months, and knee flexor torque LSI at 12 ( p = 0.001) and 24 ( p = 0.039) months. Females undergoing ACLR with a QT (vs. HT) graft demonstrated a lower knee extensor torque LSI at 12 ( p = 0.006) months, a lower lateral hop LSI at 12 ( p = 0.038) months, and a lower medial hop LSI at 12 ( p = 0.042) months. Conclusions Females reported less activity and psychological readiness, as well as strength symmetry. Furthermore, the recovery of quadriceps strength and hop symmetry was delayed in females (vs. males) undergoing ACLR with a QT graft. A better understanding of these differences will assist in counselling on expectations, determining the most appropriate graft construct and permitting more targeted rehabilitation. Level of Evidence Level IV.
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