Evaluating Donor-Recipient Sex Mismatch in Anterior Cruciate Ligament Reconstruction With Allograft: Outcomes at 2 Years Postoperatively.

Background: Female patients tend to suffer a greater risk of reinjury and worse patient-reported outcome measures (PROMs) after anterior cruciate ligament reconstruction (ACLR) than male patients, regardless of the graft type used. Purpose/Hypothesis: This study explored the role of donor-recipient sex mismatching to help explain these sex-based disparities in outcomes after ACLR with an allograft. The hypothesis was that allograft donor-recipient sex mismatch would adversely affect surgical outcomes at a 2-year follow-up, with male-to-female graft donations yielding the lowest rates of success. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary ACLR with an allograft between 2012 and 2022 were eligible for recruitment. The following PROMs were collected from baseline through a 2-year follow-up: Knee injury and Osteoarthritis Outcome Score subscales, Marx activity rating scale, visual analog scale for pain, and Veterans RAND 12-Item Health Survey. Demographic and graft-specific variables were also collected. Sex- Results: Of the 112 included patients (N = 70 women), 59 (52.7%) were sex mismatched. The mean patient age was 40.7 ± 10.9 years, and the mean body mass index was 26.8 ± 4.7 kg/m Conclusion: The study findings indicated that male donors provided larger allografts than female donors, and that donor-recipient allograft sex matching did not contribute significantly to ACLR outcomes. Other factors may be more important to outcomes in female patients.