Background:

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.

Study Design:

Controlled laboratory study

Methods:

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.

Results:

Females had significantly worse mean total macroscopic cartilage damage scores on the surgical side (adjusted P value [P adj] = .04) and significantly better scores on the contralateral side (P adj = .01) when compared with males. The trochlear damage scores were also significantly worse in females for surgical limbs (P adj = .009) and significantly better for the contralateral limbs (P 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, P adj = 0.45; ACL reconstruction, P adj = .56; bridge-enhanced ACL restoration, P adj = .23), the mean trochlear scores on the surgical limb of females were significantly worse than those of the males in the ACLT group (P adj = .003).

Conclusion:

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.

Clinical Relevance:

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.

中文翻译：

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男性和女性性别对猪膝关节前交叉韧带术后创伤后骨关节炎发展的影响

背景：

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的研究较少。

目的/假设：

该研究的目的是比较雄性和雌性尤卡坦小型猪 ACL 手术后发生的宏观软骨损伤。据推测，ACL 手术后，雌性动物胫股关节的宏观软骨损伤将大于雄性动物。此外，据推测，性对宏观软骨损伤的影响取决于手术治疗。

学习规划：

受控实验室研究

方法：

获得了 55 只青少年尤卡坦小型猪（22 只雌性/33 只雄性）的 12 个月随访数据，这些数据被随机分为 3 个实验组中的一组：不治疗（ACL 横断 [ACLT]）、ACL 重建和桥增强 ACL 恢复。使用骨关节炎研究协会国际指南来确定膝关节 5 个表面的标准化宏观软骨损伤评分。

结果：

与男性相比，女性手术侧的平均总宏观软骨损伤评分明显较差（调整后的P值 [ P adj] = .04），而对侧的评分明显更好（P adj = .01）。与男性相比，女性手术肢体的滑车损伤评分也明显较差 ( P adj = .009)，而对侧肢体的滑车损伤评分则明显更好 ( P adj < .001)。尽管在手术肢体的治疗组中，性别之间的总宏观软骨损伤评分没有显着差异（ACLT，P adj = 0.45；ACL 重建，P调整=.56；桥增强 ACL 修复，P adj = .23），ACLT 组中女性手术肢体的平均滑车评分显着差于男性（P adj = .003）。

结论：

无论进行何种治疗，尤卡坦半岛小型猪的平均总宏观软骨损伤评分在雌性中均显着低于雄性。这些差异主要存在于所有治疗组的滑车评分中。

临床相关性：

这些数据表明，患者性别对 ACL 损伤后 PTOA 进展的影响可能比手术治疗更大。确定造成这种差异的因素对于确定减缓男性和女性 ACL 损伤人群中 PTOA 进展的目标可能很有价值。