A Comparison of Psychological Readiness and Patient-Reported Function Between Sexes After Anterior Cruciate Ligament Reconstruction

Abstract

Context Postoperative functional and return-to-sport outcomes after anterior cruciate ligament reconstruction (ACLR) differ by sex. However, whether sex disparities are observed in patient-reported outcome measures (PROMS) before return to sport after ACLR is unclear. Objectives To compare common PROMS between young men and women who had not yet returned to sport after ACLR. Design Cross-sectional study. Setting University laboratory. Main Outcome Measure(s) Forty-five young men (age = 18.7 ± 2.7 years, time since surgery = 6.8 ± 1.4 months) and 45 matched for age (±1 year) and time since surgery (±1 month; age = 18.8 ± 2.8 years, time since surgery = 6.9 ± 1.4 months) with ACLR participated. Participants completed the Tegner Activity Scale, ACL Return to Sport After Injury scale, Tampa Scale of Kinesiophobia, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). The PROMS were compared between men and women using Mann-Whitney U tests. Odds ratios were calculated to evaluate the odds of a male reporting a PROM value above the previously established normative value as compared with a female. Results Sex differences were present for the IKDC score (P = .01) and KOOS Pain score (P = .04) but not for the Tegner activity level (P = .22), ACL Return to Sport after Injury scale score (P = .78), Tampa Scale of Kinesiophobia score (P = .64), or other KOOS subscales (P values = .40 to .52). The odds of reporting values above normative levels differed only for the IKDC score (odds ratio = 2.72, 95% confidence level = 1.16, 6.38). Conclusions After ACLR, young men and women reported similar levels of knee-related function, fear of movement, and readiness for return to sport and were equally likely to meet clinically meaningful normative values before return to sport. Overreliance on patient reports or objective functional outcomes in evaluating patient progress and readiness for return to sport after ACLR may limit clinicians in their ability to comprehensively evaluate and develop individualized interventional approaches that optimize patient outcomes.

Effects of Initial Graft Tension and Patient Sex on Knee Osteoarthritis Outcomes After ACL Reconstruction: A Randomized Controlled Clinical Trial With 10- to 12-Year Follow-up

“…Previous studies have reported female sex as a risk factor for worse KOOS (Sport, 2 QOL, 2 and Pain 30 ), knee laxity, 42,47,53 SF-36 (physical role limitations, bodily pain, and general health), 17 and IKDC examination 30,53 outcomes after ACLR, whereas the present study detected no sex differences in these assessments. Although the reasons for these discrepancies remain unclear, it is important to note that the referenced studies were conducted with short- to midterm follow-up, whereas the present study was conducted with longer-term follow-up.…”

Effect of Age and Sex on Psychological Readiness and Patient-Reported Outcomes 6 Months After Primary ACL Reconstruction

“…1 Of note, other authors have shown no significant differences in psychological readiness by sex; thus, it is unclear whether the sex differences observed in this study are truly generalizable. 2,19,22 The effect of age on outcomes after ACLR has become particularly concerning, as it has been shown that patients who are <20 years old can be 3 to 6 times more likely to sustain a second ACL injury. 41 Given this high rate of reinjury among younger patients, many studies have sought to identify risk factors predisposing patients to reinjury.…”

Wide Variability in Return-to-Sport Criteria used by Team Physicians After Anterior Cruciate Ligament Reconstruction in Elite Athletes—A Qualitative Study

“…The lack of utility of PROMs in RTS decision making observed in the current study may be supported by some authors, who report a limited association between patient reports and psychological readiness, for example, when comparing patients of different sexes. 31 Another important RTS criterion referred to by the team physicians was time since the ACLR surgery. Burgi et al 19 reported that 178 (85%) of the 209 studies included in their review used time as an RTS criterion after primary ACLR.…”

“…The lack of utility of PROMs in RTS decision making observed in the current study may be supported by some authors, who report a limited association between patient reports and psychological readiness, for example, when comparing patients of different sexes. 31 …”