Olivia A. Anderson 1, Allen L. Redinger1, Emery L. Mintz 2,3, Caleb C. Voskuil 2, Jason A. Mogonye 3,4, Joshua C. Carr 2,3 & Breanne S. Baker 1

1 Oklahoma State University, Stillwater, Oklahoma; 2 Texas Christian University, Fort Worth, Texas; 3 Texas Christian University School of Medicine, Fort Worth, Texas; 4 JPS Health Network, Fort Worth, Texas

Females are predisposed to more risk factors for primary and secondary anterior cruciate ligament (ACL) injury. Factors such as lower-body bone, muscle, and fat tissue asymmetries post-ACL reconstruction (ACLR) influence recovery; however, if these asymmetries are sex-specific is unknown. PURPOSE: This study aimed to evaluate the influence of sex on musculoskeletal asymmetries and perception of knee function post-ACLR. METHODS: Females (n=11) and males (n=11) with a history of ACLR provided voluntary informed consent prior to completing Dual-energy X-ray Absorptiometry (DXA) scans to measure lower-body bone mineral content (BMC), Fat %, and lean mass (LM), additionally inter-limb asymmetry indices (AI%) were calculated for each tissue. Perceptions of knee function were captured via the International Knee Documentation Committee (IKDC) instrument and participants provided surgical information such as time since surgery and graft type used. Initial Independent t-tests were used to assess sex differences for all variables; however, time since surgery was included as a clinically significant covariate for subsequent analyses. Additionally, Pearson’s Correlations Coefficients evaluated the association between AI% and IKDC scores. Lastly, Cohen’s effect sizes (d) were calculated and α=0.05. RESULTS: Females had greater asymmetries for BMC and LM and lower IKDC scores compared to males post-ACLR (adjusted p≤0.027, d=0.40–0.74). Furthermore, a sex-dependent correlation was observed as tissue asymmetries were negatively correlated with IKDC scores for only females (all r≥0.755; p≤0.007). CONCLUSIONS: These data suggested females with a history of ACLR have greater musculoskeletal tissue asymmetries compared to males, which are associated with lower perceptions of knee function. As such, sex-specific ACLR rehabilitation and musculoskeletal monitoring protocols may need to be developed as we aim to reduce females’ elevated risk for ACL reinjury.

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Figure 1

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