A Between Sex Comparison of Anterior-Posterior Knee Laxity after Anterior Cruciate Ligament Reconstruction with Patellar Tendon or Hamstrings Autograft

Abstract

Anterior-posterior (AP) knee laxity after anterior cruciate ligament (ACL) reconstruction may differ between sexes for different graft types. Females may experience an increase in AP knee laxity following an ACL reconstruction with a hamstrings graft, which is not seen in males with a hamstrings graft or in males or females with a bone-patellar tendon-bone (BTB) graft. The hypothesis of this review is sex differences in AP knee laxity and this will be identified in patients who undergo an ACL reconstruction with a hamstrings graft, while no sex differences will be observed in patients who have an ACL reconstruction with a BTB graft. A systematic search was performed in PubMed, CINAHL® and SPORTDiscus™. Inclusion criteria were articles published in the English language that studied human subjects who underwent an ACL reconstruction with a BTB or hamstrings autograft, and the presence of a sex comparison on outcome measures including side-to-side difference in AP knee laxity. Methodological quality was assessed using a Modified Coleman Methodology Score. Eleven cohort studies met the inclusion criteria. Six investigated sex differences in both hamstrings and BTB grafts. Three only investigated BTB grafts and two only investigated hamstrings grafts. These studies consistently reported increases in AP knee laxity in females after an ACL reconstruction with a hamstrings graft that was not observed in the other cohorts. This systematic review indicates that female patients have greater AP knee laxity following an ACL reconstruction with a hamstrings autograft compared with males with a similar procedure, and both females and males following an ACL reconstruction with a BTB autograft. These results are derived from lower level evidence, as no randomized control trials have attempted to answer this question. Future studies need to rigorously address this clinical question to confirm the results currently in the literature.

Knee joint laxity and passive stiffness in meniscectomized patients compared with healthy controls

“…Previous reports have shown that patients undergoing ACL reconstruction have increased AP laxity [14]. Given the stabilizing function of the meniscus in the knee joint, [30] albeit small [31], we hypothesized that arthroscopic partial medial meniscectomy could increase knee joint laxity.…”

“…Most studies investigating knee joint laxity after knee surgery have investigated ACL reconstructed patients, showing increased laxity [14] and altered knee joint mechanics [15]. Less is known about these in patients with a prior meniscectomy, a group at particularly high risk of knee OA [16][17][18].…”

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

“…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.…”

Different Techniques of ACL Reconstruction: Guidelines

“…A systematic review has shown that the stability in women who were treated with a hamstring tendon graft is less than in female patients who were treated with a patellar tendon autograft (Paterno et al 2012). Possible explanations involve gender-related differences in bone mineral density or the loss of an active valgus stabilizer.…”