The use of patellar tendon autograft and lateral meniscus repair are associated with loss of motion of the knee among female patients undergoing anterior cruciate ligament reconstruction

PURPOSE: To conduct a sex-stratified analysis of factors associated with subsequent surgery for loss of motion after anterior cruciate ligament reconstruction (ACLR), including meniscus repair and graft type. METHODS: All individuals age ≥14 years who underwent primary ACLR between 2014 and 2021 were reviewed. Exclusion criteria included <6 months follow-up and concomitant meniscal root, multiligament, osteochondral or osteotomy procedures. The primary outcome was subsequent surgery for loss of motion. Demographic and surgical variables were compared between individuals who underwent subsequent surgery for loss of motion versus not, for the full cohort and among females and males separately. Significance was set to p < 0.050. RESULTS: A total of 1226 individuals (age: 25 ± 10 years; 49% female) were included at a mean follow-up of 2.3 years. The rate of subsequent surgery for loss of motion was 9.0% for the full cohort, 12.3% for females and 5.9% for males. Among the full cohort, female sex (OR: 2.31; p < 0.001) and lateral meniscus (LM) repair (OR: 1.62; p = 0.048) were predictors of subsequent surgery for loss of motion. Among females, bone-patellar tendon-bone (BPTB) autograft use (OR: 1.91; p = 0.034) and LM repair (OR: 1.72; p = 0.046) were predictors of subsequent surgery for loss of motion, with combined BPTB autograft use and LM repair resulting in a significantly higher rate of subsequent surgery for loss of motion (32% vs. 12%; p = 0.004). Among males, graft type and meniscus repair were not associated with subsequent surgery for loss of motion (both p > 0.050). CONCLUSION: In this sex-stratified analysis, BPTB autograft use and LM repair were identified as factors predictive of subsequent surgery for loss of motion after primary ACLR when analysing females independently, while no predictive factors were identified when analysing males independently. Understanding factors associated with loss of motion after primary ACLR among males and females separately may guide individualised surgical decision-making and patient counselling. LEVEL OF EVIDENCE: Level III, retrospective cohort study.