Improvement Trajectories in Patient-Reported Outcomes Between Males and Females After Anterior Cruciate Ligament Reconstruction

Elizabeth Bjornsen; Caroline Lisee; Todd A Schwartz; Robert Creighton; Ganesh Kamath; Jeffrey Spang; Troy Blackburn; Brian Pietrosimone

doi:10.4085/1062-6050-0093.22

Improvement Trajectories in Patient-Reported Outcomes Between Males and Females After Anterior Cruciate Ligament Reconstruction

J Athl Train. 2023 May 1;58(5):430-436. doi: 10.4085/1062-6050-0093.22.

Authors

Elizabeth Bjornsen¹, Caroline Lisee², Todd A Schwartz^{1

2

3}, Robert Creighton⁴, Ganesh Kamath⁴, Jeffrey Spang⁴, Troy Blackburn², Brian Pietrosimone²

Affiliations

¹ Human Movement Science Curriculum.
² Department of Exercise and Sport Science.
³ Department of Biostatistics, Gillings School of Global Public Health.
⁴ Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill.

PMID: 35788341
DOI: 10.4085/1062-6050-0093.22

Abstract

Context: Patient-reported outcomes (PROs) are used to track recovery and inform clinical decision-making after anterior cruciate ligament reconstruction (ACLR). Whether sex influences the trajectory of improvements in PROs over time post-ACLR remains unclear.

Objectives: To (1) examine the effect of sex on the association between months post-ACLR and Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QOL) scores in individuals with ACLR and (2) assess sex differences in the KOOS QOL score at selected timepoints post-ACLR.

Design: Cross-sectional study.

Setting: Laboratory.

Patients or other participants: A total of 133 females (20± 3 years) and 85 males (22 ± 4 years) within 6 to 60 months of primary, unilateral ACLR.

Main outcome measure(s): The KOOS QOL was completed at a single follow-up timepoint post-ACLR. A multivariate linear regression model was calculated to assess the interaction of sex on the association between months post-ACLR and KOOS QOL score. Sex-specific linear regression models were then used to predict KOOS QOL estimated marginal means at each clinical timepoint (6, 12, 24, 36, 48, and 60 months post-ACLR) and compare the sexes.

Results: In the primary model (R2 = 0.16, P < .0001), a significant interaction existed between sex and time post-ACLR (β = -0.46, P < .01). Greater months post-ACLR were associated with better KOOS QOL scores for males (R2 = 0.29, β = 0.69, P < .001); months post-ACLR was a weaker predictor of KOOS QOL scores for females (R2 = 0.04, β = 0.23, P < .02). Estimated marginal means for KOOS QOL scores were greater for males than females at 36 months (t210 = 2.76, P < .01), 48 months (t210 = 3.02, P < .01), and 60 months (t210 = 3.09, P = .02) post-ACLR.

Conclusions: Males exhibited PRO improvement post-ACLR as the months post-ACLR increased, whereas females did not demonstrate the same magnitude of linear increase in KOOS QOL score. Females may require extended intervention to improve clinical outcomes post-ACLR and address a plateau in QOL score.

Keywords: Knee injury and Osteoarthritis Outcome Quality of Life score; self-reported outcomes; sex differences.

MeSH terms

Anterior Cruciate Ligament Injuries* / surgery
Anterior Cruciate Ligament Reconstruction*
Cross-Sectional Studies
Female
Humans
Knee Joint / surgery
Male
Patient Reported Outcome Measures
Quality of Life