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Natalie Lowenstein, BS

Pronouns

Rank

Grad Student

Institution

Brigham and Women's Hospital

Department

Orthopaedics

Authors

Connor Crutchfield, Natalie Lowenstein, Chilan Liete, Christian Lattermann, Elizabeth Matzkin

Principal Investigator

Elizabeth Matzkin

Categories:

Association of Sex Mismatch Between Allograft Donor and Recipient With 2-Year Surgical Outcomes After Anterior Cruciate Ligament Reconstruction

Abstract

Introduction: It is well-known that the risk of ACL injury is higher in females. Female patients also tend to suffer greater risk of re-injury and worse patient-reported outcome measures (PROMs) after ACL reconstruction (ACLR), regardless of the graft type used. The causative elements of these disparities, however, have not been elucidated.

Purpose: To explore the potential role of donor-recipient sex mismatching in postoperative outcomes following ACLR with allograft.

Methods: Patients who underwent primary ACLR with an allograft between 2012-2022 were eligible for recruitment. Graft-specific variables and the following PROMs were collected at baseline with 2-year follow-up: the Knee Injury and Osteoarthritis Outcome Score pain and function subscales, Marx Activity Scale, Visual Analogue Scale, and Veteran’s Rand-12. Sex “matched” cases were compared to “mismatched” cases and an identical sub-analysis was performed for female patients only.

Results: Of the 113 patients analyzed, 60 were sex-mismatched. The average age of patients was 39.6±11.5 years. The majority of cases (89.4%) used a semitendinosus graft and the mean implanted graft diameter was 9.6±0.6mm (quadrupled). Of the mismatched cases, 96.7% involved a male-to-female allograft donation. The Marx Activity score was greater at baseline and at 1 year in the sex-matched group (P<0.05 for both), PROMs also tended to be better at all time points in the matched group. In the female-only sub-analysis, mismatched cases tended to have better PROMs postoperatively. Interestingly, the quadrupled male allografts implanted in these patients were also larger on average (9.3±0.4mm vs. 9.7±0.6mm, P=0.002).

Conclusion: These findings suggest donor-recipient sex matching does not contribute significantly to the outcomes of ACLR with allograft.”

Research Context

Sex differences are seen throughout the field of orthopaedic surgery. Outcomes following orthopaedic surgery can vary based on sex. In addition, research on ACL reconstruction has demonstrated that females have a higher incidence of injury and worse outcomes following surgery than their male counterparts. This study explores the role of donor-recipient sex mismatching in postoperative outcomes following ACLR with allograft. We found that donor-recipient sex matching of allografts did not significantly affect ACLR outcomes. In sex-matched cases, PROM scores tended to be better at all time points in the general cohort, but worse when only female recipients were examined. These findings can inform surgeon graft choice decision making as they suggest that donor-recipient sex matching does not contribute significantly to the outcomes of ACLR with an allograft.