38 Gender differences after anterior cruciate ligament reconstru(~tion. L. Salmon .1, L. Pinczewski 1, K. Refshauge 2 & V. Russell 1 1Australian Institute Of Musculoskeletal Research 2University of Sydney

Background: It is now well documented that females are more likely to suffer ACL injury than males. Afew studies have examined gender difference in the outcome of ACL reconstruction with patellar tendon graft but no well controlled studies have specifically compared males and females after ACL reconstruction with hamstring tendon graft and interference screw fixation. Methods: 100 males and 100 females underwent isolated ACL reconstruction by a single surgeon. Assessment was performed preoperatively and at 1,2 and 7 years after surgery and included the IKDC Knee Ligament Evaluation Form, instrumented testing with the KT1000 arthrometer and single leg hop test. Radiographs were performed at 2 and 7 years. Results were compared between female and male patients. Results: Physical ligament evaluation displayed greater laxity in female patients on Lachman (p=0.04), Pivot shift (p=0.05) and mean manual maximum testing (p=0.05) at 7 years. However the magnitude of this difference was small. No patients had a greater than grade 1 Lachman or Pivot shift test and the mean difference between males and females was 0.6mm. Subjectively, there was no difference between males and females for subjective knee function or symptoms of instability with activity. Significantly more male patients than female patients displayed loss of extension at 2 years (p=0.03), but no difference was found at 7 years (p=0.30). There was no significant difference between males and females in the percentage of patients with a normal radiological examination at either 2 or 7 years. Conclusions: ACL reconstruction using hamstring tendon autograft affords excellent subjective and objective results in both males and females after 7 years. Significantly greater laxity on physical examination is present in female patients when compared to males, but the magnitude of this difference is small and had no effect on activity level, graft failure, subjective or functional assessment. We feel that hamstring tendon graft for ACL reconstruction remains superior to the patellar tendon graft in both males and females.

39 Graft selection for anterior cruciate ligament reconstruction in the female athlete K. Webster*, R. Siebold, J. Eliiott & J. Feller Musculoskeletal Research Centre, La Trobe University

Anterior cruciate ligament (ACL) reconstruction using hamstring tendon (HS) grafts has often been recommended for the female athlete. However, recent work has suggested that the results of ACL reconstruction in females using HS grafts are inferior to those using patellar tendon (PT) grafts. The purpose of this study was to compare the mid-term results of ACL reconstruction in female athletes using both graft types. Sixty-six females who had undergone primary ACL reconstruction within 12 months of injury using either HS (n=43) or PT autograft (n=23) were evaluated at a mean 3.8 years follow-up (range 2.6 - 5.5). Evaluation included IKDC 2000, SF-36, Cincinnati Sports Activity scores and measurements of anterior knee pain (AKP), kneeling pain, range of motion and anterior knee laxity (KT-1000). One patient in the PT group sustained a traumatic graft rupture. For the remaining patients there were no differences between the two graft types in terms of IKDC scores or anterior knee laxity. Sports Activity scores were significantly higher in the HS group. For the SF-36, the HS group also scored significantly higher on Physical Functioning and General Health subscales. Although there was no significant difference in AKP between the two groups, there was significantly greater kneeling pain in the PT group. The PT group also had significantly greater extension deficits. These findings show that whilst both HS and PT ACL reconstruction appear to provide satisfactory results in females, HS grafts were associated with fewer symptoms, a greater return to preinjury level of activity and higher quality of life scores.

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