Anterior cruciate ligament reconstruction in men and women

PURPOSE: Recent studies have shown that female athletes suffer a higher incidence of anterior cruciate ligament (ACL) tears than comparable male athletes. The purpose of this study was to evaluate the effect gender has on outcome in ACL reconstruction using bone-patellar tendon-bone autograft. TYPE OF STUDY: Retrospective case review and outcome study. METHODS: A retrospective review of a single surgeon's practice revealed 279 ACL reconstructions that met our criteria for inclusion. Two-hundred forty-nine of these patients (91%) were contacted. Two-hundred (72%) were evaluated with physical examination, KT-1000 testing, functional testing, and radiographic evaluation. Outcome was assessed with Tegner, Lysholm, modified HSS, and Cincinnati Knee rating scales, as well as the SF-36 health survey and a self-administered questionnaire. There were 137 men and 63 women. Data were evaluated with Wilcoxon rank sum testing, analysis of variance testing, chi-square analysis, and the Student t test. The level of significance was set at P <.05. RESULTS: Postoperatively, no differences were noted on Lachman, anterior drawer, pivot shift, or functional testing in either groups. Male patients had a significantly greater mean prone heel height difference (1.80 v 1.10 cm, P =.0018) and mean KT-1000 maximum manual side-to-side difference (0.76 v 1.73 mm, P =.014). However, no differences were noted in the percentage of patients with greater than 5-mm side-to-side difference, with 5 men (4%) and 2 women (3%) classified as arthrometric failures. No differences were noted in mean Tegner, Lysholm, Noyes Cincinnati, and modified HSS scores. Men had significantly lower HSS radiographic scores (24.98 v 26.22, P =.0016). Men and women were compared with gender-matched controls for SF-36 testing, and women scored higher compared with controls than did men in the Role Physical, Body Pain, and General Health categories. No differences were noted in either group regarding donor-site pain, patellofemoral crepitance, or problems with stair climbing. Ninety-six percent of men and 98% of women would have had the surgery over again given similar circumstances. CONCLUSIONS: Objective criteria failed to detect clinically significant differences in physical examination and arthrometric results between men and women. Knee rating scale scores were similar. Comparable outcome with high satisfaction and equal success can be expected in both men and women undergoing ACL reconstruction using bone-patellar tendon-bone autograft. No basis exists for the inclusion of gender as a determining factor regarding the decision to perform ACL reconstructive surgery with bone-patellar tendon-bone autograft.