Kurt P. Spindler, MD, Dana P. Piasecki, Jack T. Andrish, MD, Richard D. Parker,
MD,
and Todd A. Warren, ACNP
Objective:
Intraarticular (IA) injuries to articular cartilage and meniscus are presumed
risk factors for long-term outcome after ACL tears. No study has investigated
whether gender differences in IA injuries exist in athletes within same sport
and competition level. We investigated IA injuries and mechanism of a singular
acute ACL tear between males and females in the same sport at the same level
of competition.
Methods:
Athletes who were enrolled in a prospective ACL database were evaluated based
on the following inclusion criteria: participation at similar levels of competition
(high school [HS] vs amateur or recreational), same sports (basketball [BB],
soccer, skiing), and normal bilateral knee histories before sustaining acute
ACL tear as a singular event. Two hundred twenty athletes fit these criteria.
Age, sex, weight, and height were documented. Information related to the mechanism
of injury included side, contact, jumping, pop, ability to continue to play,
and degree and timing of swelling. IA findings were recorded in surgery including
meniscus, articular cartilage, posterior cruciate ligament and collateral ligament
injuries. Statistical evaluation was chi square for categorical variables and
student’s t-test for continuous variables with p=0.05 for significance.
Results:
At the HS level females had significantly fewer medial meniscus (MM) tears in
soccer (p=0.02) and medial femoral condyle (MFC) articular cartilage injuries
in basketball. There were no significant differences in mechanism of injury
with approximately 2/3 noncontact and jumping mechanism. In amateur and recreational
level basketball, females had significantly more contact injuries (62% vs 23%,
p=0.02), onset of swelling (p=0.03), and fewer lateral meniscus tears (p=0.01).
As anticipated, females were lighter and smaller.
Conclusions:
We hypothesize the reduced frequency of IA injuries observed at high school
level in females in soccer (MM) and basketball could lead to better long-term
functional outcomes after ACL reconstruction given equal stability. Long-term
evaluation for activity level, function, and arthritis is currently being evaluated.
Since there are significant differences in articular cartilage injuries and
meniscus tears, further detailed investigation into mechanism of injury, anatomic
knee differences, and arthropometric measurements is needed.