{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:17:56Z","timestamp":1788391076843,"version":"build-2803163510"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Contemporary anterior cruciate ligament reconstruction (ACLR) techniques have evolved, but whether these changes differ by sex remains unclear. This study evaluated sex-based temporal trends in graft selection, fixation strategy, and suture augmentation after primary ACLR. Following Institutional Review Board approval, a retrospective cohort study was performed within a large multicenter health system, which evaluated all primary ACLR procedures performed between 2014 and 2022 and were identified using Current Procedural Terminology code 29888. Adult patients (\u226518 years) were included, while those with multiligamentous injuries or revision ACLR were excluded. Demographic and operative variables were analyzed by sex, and temporal trends were assessed using correlation and categorical analyses. A two-sided p-value &lt;0.05 was considered statistically significant. Of 2,695 primary ACLR procedures identified, 1,781 met inclusion criteria, including 583 female patients (32.7%) and 1,198 male patients (67.3%), with a mean age of 31.2\u2009\u00b1\u200910.6 years. Autograft was used in 1,162 cases (65.2%). Autograft utilization was lower in females than males (58.5% vs. 68.5%, p\u2009&lt;\u20090.001). Among females \u226425 years, allograft use declined from 26.3% in 2014 to 0.0% by 2022 (r\u2009=\u2009\u2212\u20090.722, p\u2009=\u20090.015). Overall quadriceps tendon graft utilization, including both autograft and allograft sources, increased in both sexes, reaching 20.5% in females and 16.7% in males by 2022. In temporal analyses, quadriceps tendon allograft utilization increased among females (r\u2009=\u20090.719, p\u2009=\u20090.029), while quadriceps tendon autograft utilization increased among males (r\u2009=\u20090.772, p\u2009=\u20090.015). Suspensory fixation (r\u2009=\u20090.703, p\u2009=\u20090.034) and suture augmentation (r\u2009=\u20090.765, p\u2009=\u20090.016) increased significantly among female patients over time, while pin fixation declined in both females (r\u2009=\u2009\u2212\u20090.692, p\u2009=\u20090.039) and males (r\u2009=\u2009\u2212\u20090.765, p\u2009=\u20090.016). These findings demonstrated that contemporary ACLR technique selection evolved in a sex-specific manner, with distinct patterns in graft adoption and fixation strategy consistent with changing operative preferences over time.<\/jats:p>","DOI":"10.1055\/a-2939-2425","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T23:04:27Z","timestamp":1787094267000},"source":"Crossref","is-referenced-by-count":0,"title":["Declining Allograft Use in Young Females, Increasing Quadriceps Tendon Use, and Female-specific Adoption of Suspensory Fixation and Suture Augmentation During Anterior Cruciate Ligament Reconstruction"],"prefix":"10.1055","author":[{"given":"Tracy M.","family":"Tauro","sequence":"additional","affiliation":[{"name":"Northwell Health, New York, United States","place":["New Hyde Park"],"department":["Department of Orthopaedic Surgery"]},{"name":"Huntington Hospital, New York, United States","place":["Huntington"],"department":["Department of Orthopaedic Surgery"]},{"name":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, New York, United States","place":["Hempstead"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4536-1278","authenticated-orcid":false,"given":"Benjamin","family":"Hershfeld","sequence":"additional","affiliation":[{"name":"Northwell Health, New York, United States","place":["New Hyde Park"],"department":["Department of Orthopaedic Surgery"]},{"name":"Huntington Hospital, New York, United States","place":["Huntington"],"department":["Department of Orthopaedic Surgery"]},{"name":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, New York, United States","place":["Hempstead"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shebin","family":"Tharakan","sequence":"additional","affiliation":[{"name":"Nassau University Medical Center, New York, United States","place":["East Meadow"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Klein","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine, Pennsylvania, United States","place":["Philadelphia"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy M.","family":"Cohn","sequence":"additional","affiliation":[{"name":"Northwell Health, New York, United States","place":["New Hyde Park"],"department":["Department of Orthopaedic Surgery"]},{"name":"Long Island Jewish Valley Stream, New York, United States","place":["Valley Stream"],"department":["Department of Orthopaedic Surgery"]},{"name":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, New York, United States","place":["Hempstead"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A.","family":"Sgaglione","sequence":"additional","affiliation":[{"name":"Northwell Health, New York, United States","place":["New Hyde Park"],"department":["Department of Orthopaedic Surgery"]},{"name":"Long Island Jewish Medical Center, New York, United States","place":["Hempstead"],"department":["Department of Orthopaedic Surgery"]},{"name":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, New York, United States","place":["Hempstead"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"531","DOI":"10.5435\/JAAOS-D-22-01020","article-title":"American Academy of Orthopaedic Surgeons clinical practice guideline summary: management of anterior cruciate ligament injuries","volume":"31","author":"R H Brophy","year":"2023","journal-title":"J Am Acad Orthop Surg"},{"issue":"24","key":"ref2","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1056\/NEJMcp1805931","article-title":"Anterior cruciate ligament tear","volume":"380","author":"V Musahl","year":"2019","journal-title":"N Engl J Med"},{"issue":"11","key":"ref3","doi-asserted-by":"crossref","first-page":"3871","DOI":"10.1007\/s00167-021-06443-9","article-title":"ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades","volume":"29","author":"M P Arnold","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s00167-022-07057-5","article-title":"Surgeon's experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries","volume":"31","author":"D Rizvanovic","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"10","key":"ref5","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1136\/bjsports-2022-106099","article-title":"Let's talk about sex (and gender) after ACL injury: a systematic review and meta-analysis of self-reported activity and knee-related outcomes","volume":"57","author":"A M Bruder","year":"2023","journal-title":"Br J Sports Med"},{"issue":"08","key":"ref6","doi-asserted-by":"crossref","first-page":"e663","DOI":"10.1097\/BPO.0000000000002983","article-title":"Age and sex-based frequency of graft and technique used in pediatric anterior cruciate ligament reconstruction: a multicenter study","volume":"45","author":"E L Niu","year":"2025","journal-title":"J Pediatr Orthop"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1177\/03635465231222267","article-title":"Risk of revision and reoperation after quadriceps tendon autograft ACL reconstruction compared with patellar tendon and hamstring autografts in a US cohort of 21,973 patients","volume":"52","author":"J S Yang","year":"2024","journal-title":"Am J Sports Med"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1136\/bjsports-2017-098769","article-title":"Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often","volume":"52","author":"A J Sheean","year":"2018","journal-title":"Br J Sports Med"},{"issue":"12","key":"ref9","doi-asserted-by":"crossref","first-page":"3425","DOI":"10.1177\/03635465211030259","article-title":"Quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and meta-analysis","volume":"50","author":"W Dai","year":"2022","journal-title":"Am J Sports Med"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/JSM.0000000000000765","article-title":"A comparison of quadriceps tendon autograft with bone-patellar tendon-bone autograft and hamstring tendon autograft for primary anterior cruciate ligament reconstruction: a systematic review and quantitative synthesis","volume":"31","author":"P Ajrawat","year":"2021","journal-title":"Clin J Sport Med"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1177\/03635465221146299","article-title":"Comparative study of ACL reconstruction with hamstring versus patellar tendon graft in young women: a cohort study from the New Zealand ACL Registry","volume":"51","author":"A Tiplady","year":"2023","journal-title":"Am J Sports Med"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1016\/j.arthro.2021.01.042","article-title":"Anterior cruciate ligament reconstruction graft preference most dependent on patient age: a survey of United States surgeons","volume":"37","author":"E N Bowman","year":"2021","journal-title":"Arthroscopy"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.arthro.2023.11.005","article-title":"Anterior cruciate ligament reconstruction: fixation techniques","volume":"40","author":"E R McDermott","year":"2024","journal-title":"Arthroscopy"},{"issue":"09","key":"ref14","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1177\/03635465231196157","article-title":"Analysis of graft types augmented with an internal brace for ACL reconstruction: a systematic review","volume":"52","author":"C Maginnis","year":"2024","journal-title":"Am J Sports Med"},{"issue":"10","key":"ref15","doi-asserted-by":"crossref","first-page":"2688","DOI":"10.1002\/ksa.12426","article-title":"Females demonstrate lower levels of activity, psychological readiness and strength symmetry after anterior cruciate ligament reconstruction than males, and also recovery of quadriceps strength and hop symmetry is delayed in females undergoing reconstruction with a quadriceps tendon autograft","volume":"32","author":"J R Ebert","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"13","key":"ref16","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.2106\/JBJS.15.00881","article-title":"Surgical technique trends in primary ACL reconstruction from 2007 to 2014","volume":"98","author":"L Tibor","year":"2016","journal-title":"J Bone Joint Surg Am"},{"issue":"07","key":"ref17","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1016\/j.arthro.2020.04.023","article-title":"Comparative risk-benefit profiles of individual devices for graft fixation in anterior cruciate ligament reconstruction: a systematic review and network meta-analysis","volume":"36","author":"Y Wang","year":"2020","journal-title":"Arthroscopy"},{"issue":"10","key":"ref18","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1177\/0363546518784005","article-title":"Anterior laxity at 2 years after anterior cruciate ligament reconstruction is comparable when using adjustable-loop suspensory fixation and interference screw fixation","volume":"46","author":"A Boutsiadis","year":"2018","journal-title":"Am J Sports Med"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1186\/s12891-020-03471-3","article-title":"Is all-inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis","volume":"21","author":"C W Fu","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"issue":"07","key":"ref20","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1055\/s-0039-1685160","article-title":"Aperture and suspensory fixation equally efficacious for quadriceps tendon graft fixation in primary ACL reconstruction: a systematic review","volume":"33","author":"R J Crum","year":"2020","journal-title":"J Knee Surg"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/j.arthro.2021.06.024","article-title":"A comparison of two-year anterior cruciate ligament reconstruction clinical outcomes using all-soft tissue quadriceps tendon autograft with femoral\/tibial cortical suspensory fixation versus tibial interference screw fixation","volume":"38","author":"D N Greif","year":"2022","journal-title":"Arthroscopy"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2939-2425.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:47:12Z","timestamp":1788389232000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2939-2425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":21,"URL":"https:\/\/doi.org\/10.1055\/a-2939-2425","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8,18]]},"published":{"date-parts":[[2026,8,18]]}}}