Gender and sport as a risk factors for cartilage lesions in ACL - deficient knees.

Effect of Gender and Sports on the Risk of Full-Thickness Articular Cartilage Lesions in Anterior Cruciate Ligament -Injured Knees : A Nationwide Cohort Study From Sweden and Norway of 15 783 Patients.
Røtterud, J., Sivertsen, E., Forssblad, M., Engebretsen, L. and Årøen, A. American Journal of Sports Medicine; 2011, 39, 1387 – 1394. 
www.ajs.sagepub.com/content/39/7/1387.abstract

Knee injuries commonly result in substantial damage to articular and periarticular structures including ACL tear, meniscal and cartilage lesions. ACL rupture has been shown to be associated with increased risk of OA development, both in professional and recreational sports participants. ACL ruptures rarely occur in isolation and cartilage and meniscal lesions are often present at the time of injury. It has been reported that meniscal and cartilage injuries are strong predictors of later degenerative changes in ACL-deficient knees. Thus, identification of cartilage/meniscal lesions risk factors plays a crucial role in improving prevention and treatment. Therefore, authors decided to conduct this study on risk factors for cartilage lesions in ACL-injured knees.
Primary unilateral anterior cruciate ligament reconstructions prospectively registered in the Swedish and the Norwegian National Knee Ligament Registry during 2005 through 2008 were included (N = 15 783). Logistic regression analyses were used to evaluate risk factors for cartilage lesions.

A total of 1012 patients (6.4%) had full-thickness cartilage lesions. Results showed that males in general have an increased risk of full-thickness lesions compared with females, and male team handball players have an increased risk compared with other male athletes. The increased overall risk of cartilage lesions in males compared with females might be explained by higher levels of energy involved when the ACL tears in males. Given that males on the average have higher body weight and muscle mass than females, the energy and risk of coinjuries to the joint might increase, resulting in more severe injuries in male. Another contributory explanation of the overall gender difference might be the trauma mechanism itself, as noncontact injuries are found to be a more frequent injury mechanism in females than in males.

Furthermore, study results indicated that age, previous surgery, and time from injury to surgery exceeding 12 months are risk factors for full-thickness cartilage lesions. A possible explanation why time from injury to surgery was a risk factor could be that some full-thickness lesions occur at the time of the initial trauma, while most other lesions occur after more than 12 months because of repeated pivoting and secondary trauma to the cartilage.