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The Battle of the Sexes Meets ACL Surgery

When it comes to anterior cruciate ligament (ACL) injuries, men and women are as different as Venus and Mars. Women are four times more likely than men to tear an ACL playing basketball. And women soccer players are twice as likely to have ACL injuries as their male counterparts. But how do the sexes compare after ACL surgery? Does one gender show superior results?

Two hundred athletes had ACL reconstruction surgery. The surgeons used part of each patient's patellar tendon (the tendon just below the kneecap) to replace the ACL. After surgery, patients did a standard physical therapy program. They used a standard knee brace for the first six weeks after surgery. Then they got a custom knee brace.

One hundred thirty-seven of the patients were men. Sixty-three were women. There were some basic differences between the two groups. The women tended to be younger than the men (27 versus 30 years old). Women also had surgery sooner after injury, though both groups typically waited six weeks or more. In addition, women were examined by the authors sooner after surgery than men.

Women and men both seemed to get good results from surgery. There were only a few physical differences between them four months after surgery. On average, men had a harder time getting their knee to straighten fully compared to women, yet the men tended to have slightly better scores on tests of joint stability.

After surgery, both sexes did equally well on athletic jumping tests. They reported the same level of activity and problems with sports. They had the same amount of pain. (It wasn't severe.) Women and men also had about the same difficulty going up and down stairs.

To study the results of a general health questionnaire, the authors compared the responses of these patients with those of "average" men and women. Women in the study showed greater differences from the comparison group. In particular, the women in the study scored higher than other women on physical activity, body pain, and overall health.

Women and men were both very satisfied with their surgery. Ninety-six percent of men and 98 percent of women said they would choose surgery again.

This study shows that this form of ACL reconstruction can produce equally good results in men and women. Some surgeons believe that grafting other tendons, such as those from the hamstrings, reduces complications in women who have ACL surgery. However, based on these study results, the authors suggest the patellar tendon is still an appropriate choice for female patients having this surgery.

References: James D. Ferrari, MD, et al. Anterior Cruciate Ligament Reconstruction in Men and Women: An Outcome Analysis Comparing Gender. In Arthroscopy. July/August 2001. Vol. 17. No. 6. Pp. 588-596.

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