Purpose: Anterior cruciate ligament (ACL) tears are common in recreational and sporting activities, with ACL surgical reconstruction (ACLR) the standard treatment. Despite the increasing rate in ACL tears, especially in females, little is known about the post-operative recovery in males versus females with most studies grouping sexes. Understanding differences in the recovery between sexes will assist in better tailoring rehabilitation, return to sport (RTS) and counselling pathways toward the individual. This study sought to investigate sex-based differences in the physical and psychological recovery, as well as return to sport (RTS) pathway, of both females and males after ACLR. 

 

Methods: This prospective study recruited 104 community-level patients (49 females, 55 males) undergoing ACLR with a hamstring autograft, following injury sustained whilst participating in a pivoting sport. Patients were assessed pre-operatively and at 6, 12 and 24 months post-surgery, with a range of patient-reported outcome measures (PROMs) including the International Knee Documentation Committee form, Tegner Activity Scale and Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score. Furthermore, patients embarked on an assessment of peak isokinetic knee extensor and flexor strength and a 4-hop performance battery. Limb Symmetry Indices (LSIs) were calculated for strength and hop measures. The incidence of RTS within the 24-month period was investigated.

 

Results: Both groups were comparable (p˃0.05) when comparing baseline demographics, injury and surgery history, apart from males being heavier (p<0.001) and taller (p<0.001) than females. All PROMs employed significantly improved (p<0.05) and were comparable across sexes, apart from the ACL-RSI which was significantly lower (p=0.002) in females at 24 months post-surgery. LSIs for all physical strength and hop tests improved significantly over 24 months (p<0.001). While no sex-based differences were observed in hop test LSIs, males demonstrated significantly higher mean LSIs for peak knee extensor strength at 6 (p=0.037) and 24 (0.047) months, and significantly higher mean LSI values for peak knee flexor strength at 6 (p=0.007) and 12 (p=0.002) months. At 24-months post-surgery, a significantly greater (p=0.030) percentage of male patients had returned to pivoting sports.

 

Conclusion: The current study has demonstrated the disparity between sexes in physical and psychological recovery, as well as RTS status, in community-level patients undergoing ACLR. The development and implementation of enhanced post-operative patient-centered care may be warranted tailored to sex, encompassing rehabilitation, education, and counseling after ACLR to promote increased engagement in rehabilitation, expedited physical recovery, and improved RTS outcomes.

Disclosures: The authors have nothing to disclose.