Anterior Cruciate Ligament Allograft Reconstruction in Females Can Produce Outcomes Comparable to Those of Autografts in Male Counterparts

There are unique anatomical and geometric risk factors that contribute to higher injury rates of the anterior cruciate ligament (ACL) in women. Allografts are an important alternative option for female patients. Patients who underwent primary ACL reconstruction were retrospectively evaluated. The case group comprised female patients with ACL allograft reconstruction, and the control group comprised male patients with ACL reconstruction. Functional and clinical evaluations were based on the pre- and postoperative Cybex test, Lysholm score, International Knee Documentation Committee subjective and objective measurement criteria, and Tegner Activity Scale questionnaires. Radiological comparisons were performed using the femorotibial angle (FTA), posterior tibial slope (PTS), and intercondylar notch width (INW). The roof inclination angle (RIA) was assessed using magnetic resonance imaging. The two groups (female [44] and male [88]) had an average follow-up period of 57.9 +/- 19.3 months and average ages of 36.5 +/- 10.9 and 35.2 +/- 11.7 years, respectively. Functional and clinical outcomes showed no differences between the groups, except that the return to the preinjury activity level was higher in the female group (95% vs. 77%, p < 0.001). The female group showed larger FTA and PTS and smaller INW and RIA than those of the male group ( p < 0.001, 0.008, <0.001, and 0.035, respectively). Female ACL allograft reconstruction showed comparable outcomes to those of their male counterparts, and the return to preinjury activity levels was significantly higher in women. However, women showed lower activity levels and were more vulnerable to geometric risk factors than their male counterparts.