Summary

Both hamstring and patellar-tendon-bone grafts faired comparably in females, as well as in males, for both objective and subjective outcomes after ACL reconstruction.

Abstract

Introduction

The influence of patient sex on the choice of graft and their corresponding outcomes following ACL reconstructions remain unclear. Some studies suggest females with hamstring grafts to have inferior outcomes as compared to patellar-tendon-bone grafts or males with either graft, while others suggest no difference.

Objective

This articles aims to analyse the importance of patient sex in the choice of graft for anterior cruciate ligament reconstruction.

Methods

The review was conducted according to PRISMA guidelines. All studies that compared clinical outcomes after ACL reconstruction between either genders or grafts were included in the review. Quantitative random effects meta-analysis was performed to compare between genders and graft types. Articles were evaluated qualitatively when quantitative data were not reported.

Results

A total of 90 publications were included. No statistically and clinically significant gender or graft difference was noted for all objective parameters, including anterior-posterior laxity, graft rupture or failure and revision rates. Inferior Lysholm scores were noted amongst females as compared to males for hamstring grafts (-0.60; 95% CI: -1.05 – -0.15), and amongst hamstring grafts in both females (-1.69; 95% CI: -3.12 – -0.27) and males (-0.85; 95% CI: -1.56 – -0.14). Inferior Tegner scores were noted in females for both hamstring (-0.67; 95% CI: -1.04 – -0.29) and patellar-tendon-bone grafts (-0.36; 95% CI: -0.59 – -0.14), and in hamstring grafts as compared to patellar-tendon-bone for females (-0.49; 95% CI: -0.95 – -0.02). No significant gender or graft difference was noted for anterior knee pain.

Conclusion

Hamstring and patellar-tendon-bone grafts fair comparably in both females and males objectively. However, females with hamstring grafts have inferior Lysholm and Tegner scores as compared to their male counterparts and females with patellar-tendon-bone grafts.