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Graft selection
3%
41/1622
Size of graft
8%
134/1622
Return to sport at 11-months
5%
89/1622
Age
9%
150/1622
Gender
73%
1185/1622
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Females are twice as likely to sustain ACL tears initially. Furthermore, of the options listed, only female gender is a risk factor for re-rupture. ACL tears are more common in female athletes (4.5:1 ratio), mostly due to altered neuromuscular activation and movement coordination. For example, females tend to land with decreased hip and knee flexion, increased knee external rotation and dynamic valgus, which places increased stress on the ACL. Other factors, however, including small femoral notch size, smaller ligament girth, increased Q-angle, and hormonal differences have also been postulated. All athletes, females more commonly than males, are more likely to re-rupture their ACL graft compared to those who have never had an ACL injury. Bone-patellar-bone grafts are still considered the “gold standard”, but do have a higher incidence of anterior knee pain as well as a higher re-rupture rate in patients <20 years old and graft sizes <8mm. Stanley et al reviewed the sex differences in the incidence of ACL, MCL and meniscal injuries in collegiate and high school athletes. They report that ACL injury rates were higher in females, both in collegiate and high school participates, most commonly in basketball and softball, respectively. They conclude that there is a sex difference for incidence of ACL injuries, however, this was not seen for MCL or meniscal injuries. Paterno et al review the incidence of contralateral and ipsilateral ACL injury after primary ACL reconstruction. They report that there is an increased risk of subsequent ACL injury following ACL reconstruction, with an equal amount occurring in the ipsilateral and contralateral extremities. They conclude that female gender is a risk factor for subsequent injury, with a 15x greater risk than that of controls. Incorrect Answers: Answer 1,2, and 4: Bone-patellar-bone is considered the “gold standard” for graft selection, however, there is an increased re-rupture risk in patients <20-years-old and those whose graft is <8mm. Answer 3: Return to sport at 11-months is not associated with an increased risk of re-rupture.
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