Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA.
Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Am J Sports Med. 2022 Jul;50(9):2417-2423. doi: 10.1177/03635465221102118. Epub 2022 Jun 20.
Posttraumatic osteoarthritis (PTOA) is a common sequela of anterior cruciate ligament (ACL) injury, even when surgical treatment is selected. The effect of patient sex on cartilage health after ACL injury and surgical treatment has been less studied.
PURPOSE/HYPOTHESIS: The study objective was to compare the macroscopic cartilage damage that develops after ACL surgery in male and female Yucatan minipigs. It was hypothesized that after ACL surgery, the macroscopic cartilage damage of the tibiofemoral joints from female animals would be greater than that from male animals. Additionally, it was hypothesized that the effect of sex on the macroscopic cartilage damage would depend on surgical treatment.
Controlled laboratory study.
Twelve-month follow-up data were obtained for 55 adolescent Yucatan minipigs (22 female/33 male) that were randomized to 1 of 3 experimental groups: no treatment (ACL transection [ACLT]), ACL reconstruction, and bridge-enhanced ACL restoration. The Osteoarthritis Research Society International guidelines were used to determine a standardized macroscopic cartilage damage score on 5 surfaces of the knee joint.
Females had significantly worse mean total macroscopic cartilage damage scores on the surgical side (adjusted value [ adj] = .04) and significantly better scores on the contralateral side ( adj = .01) when compared with males. The trochlear damage scores were also significantly worse in females for surgical limbs ( adj = .009) and significantly better for the contralateral limbs ( adj < .001) when compared with males. Although there were no significant differences in total macroscopic cartilage damage scores between sexes within treatment groups on the surgical limbs (ACLT, adj = 0.45; ACL reconstruction, adj = .56; bridge-enhanced ACL restoration, adj = .23), the mean trochlear scores on the surgical limb of females were significantly worse than those of the males in the ACLT group ( adj = .003).
Mean total macroscopic cartilage damage scores of Yucatan minipigs were significantly worse in females than males, regardless of treatment. These differences were predominantly found in the trochlear scores across all treatment groups.
These data suggest that patient sex could be more influential in the progression of PTOA than surgical treatment after ACL injury. Identifying factors responsible for this discrepancy may prove valuable to identify targets to slow PTOA progression in male and female ACL-injured populations.
创伤后骨关节炎（PTOA）是前交叉韧带（ACL）损伤的常见后遗症，即使选择了手术治疗也是如此。患者性别对 ACL 损伤和手术治疗后软骨健康的影响研究较少。
目的/假设：本研究的目的是比较雄性和雌性尤卡坦迷你猪 ACL 手术后的大体软骨损伤。假设 ACL 手术后，来自雌性动物的胫股关节大体软骨损伤会大于来自雄性动物的软骨损伤。此外，还假设性别对大体软骨损伤的影响取决于手术治疗。
对照实验室研究。
对 55 只 12 个月龄的尤卡坦迷你猪（22 只雌性/33 只雄性）进行了随机分组，分为 3 个实验组：不治疗（ACL 切断术[ACLT]）、ACL 重建和桥增强 ACL 修复。使用骨关节炎研究协会国际指南来确定膝关节 5 个表面的标准化大体软骨损伤评分。
与雄性相比，雌性的手术侧平均总大体软骨损伤评分明显更差（调整值[ adj] =.04），而对侧评分明显更好（ adj =.01）。与雄性相比，雌性的滑车损伤评分在手术侧也明显更差（ adj =.009），而在对侧则明显更好（ adj <.001）。尽管在手术侧的治疗组内，性别之间的总大体软骨损伤评分无统计学差异（ACLT， adj = 0.45；ACL 重建， adj =.56；桥增强 ACL 修复， adj =.23），但雌性在 ACLT 组的手术侧滑车评分明显差于雄性（ adj =.003）。
无论治疗如何，雌性的 Yucatan 迷你猪的平均总大体软骨损伤评分均明显高于雄性。这些差异主要存在于所有治疗组的滑车评分中。
这些数据表明，与 ACL 损伤后手术治疗相比，患者性别可能更能影响 PTOA 的进展。确定导致这种差异的因素可能有助于确定在 ACL 损伤的男性和女性人群中减缓 PTOA 进展的目标。
