Document Title: BarberWestin-AJSM-Jul97.shtml
Article Title: A Rigorous Comparison Between the Sexes of Results and Complications After Anterior Cruciate Ligament Reconstruction
Authors: Sue D Barber-Westin, Frank R Noyes, Michelle Andrews
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: Jul/Aug 1997
Volume 25, Number 4, pages 514-526
Keywords: ACL reconstruction, female athlete, patellar-tendon autograft.

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Comments: The staggeringly high incidence of ACL injuries in female athletes is something which many orthopedists bear in mind when confronted with knee-ligament injuries, and the issue continues to be an ongoing stimulus for clinical research. In this penetratingly insightful and thought-provoking study, Barber-Westin et al found that a gender-based selection bias for (or against) ACL reconstruction, as a function of complications and outcome, is not warranted. This means that whether the patient is male or female should have absolutely no bearing on whether or not a ruined ACL is considered amenable to reconstruction.

ABSTRACT

Although there is a higher relative incidence of anterior cruciate ligament injuries in female than in comparable male athletes according to the literature, the majority of populations studied after reconstruction are male-dominated. We wished to determine whether a selection bias for reconstruction based on sex is warranted according to complications and outcome. Ninety-four patients (47 of each sex) were matched for chronicity of injury, age, preoperative sports activity levels, articular cartilage condition, and months of followup. All had patellar tendon autogenous reconstruction and a similar program of immediate knee motion and early return to function. The results were rated with the Cincinnati Knee Rating System. At a mean of 26 months postoperatively, there were no significant differences for complications or outcome between men and women. Women required an average of six more rehabilitation visits than men; however, none required additional surgery for knee motion complications and the rate of patellofemoral crepitus conversion was only 7%, lower than that found for men (15%). The overall failure rate was low, only 6% for women and 4% for men. We concluded that the functional rehabilitation program was effective, postoperative complications were few, and no scientific basis exists to use sex alone as a selection criteria for anterior cruciate ligament reconstruction.

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