The reporting of biological sex disaggregated data in studies on anterior cruciate ligament graft reconstruction: A systematic review.

Abstract

The anterior cruciate ligament (ACL) is one of the knee joint's most injured soft tissue structures. Increasing participation in sports has resulted in a higher incidence of ACL injuries, particularly among females, who are at a greater risk. This presents a significant healthcare burden due to pain, loss of function and post-traumatic arthritis. This systematic review aimed to determine whether specific grafts improve postoperative function for one biological sex over the other following ACL reconstruction. A search on three electronic databases (PubMed, Ovid and Cochrane) from January 2004 to June 2024 identified studies reporting Knee Injury and Osteoarthritis Outcome Score (KOOS) outcomes following ACL reconstruction. Case reports, review articles, conference abstracts, unpublished studies, and non-English articles were excluded. A total of 776 articles were found, of which 27 met the inclusion criteria. Articles were categorised into three topics: graft choice, biological sex reporting of KOOS outcomes and graft choices. Four studies reported on a single sex. Seven studies disaggregated KOOS outcomes by biological sex. Sixteen studies disaggregated graft choices by biological sex. Zero studies disaggregated both their KOOS outcomes and graft choices by biological sex. There is a significant gap in disaggregating KOOS outcomes and graft choices based on biological sex following ACL reconstruction, limiting our understanding of potential sex-specific differences in postoperative function. Future research, using existing ACL registries with a broader focus of biomechanical, hormonal and psychological data, is essential to define optimum treatment options for higher-risk patient groups, such as females.