Research priorities for ACL injuries in at-risk groups - The female population

Anterior cruciate ligament (ACL) injuries disproportionately affect female athletes, with a two-to eightfold increased risk compared to males. Using a modified Delphi approach, this study aimed to identify and prioritise key research questions regarding ACL injury prevention, diagnosis, treatment, rehabilitation, and care delivery in the female population.

A modified priority setting exercise (Delphi) was conducted with the Women's ACL Orthopaedic Steering Group, the British Orthopaedic Association (BOA), and the British Association for Surgery of the Knee (BASK). Two rounds of online surveys were distributed via Qualtrics between June and November 2024, followed by an in-person workshop on 14th November 2024. The initial poll collected research questions from patients, carers, and healthcare professionals. A systematic literature review was categorised into questions based on existing evidence. The second survey prioritised 50 questions, with the top 30 discussed at the final workshop, where the top ten research priorities were determined through structured discussion and consensus-building.

A total of 166 questions were submitted, of which 116 were deemed relevant. Following the literature review, 50 questions were included in the second survey. The final workshop, attended by 14 participants, identified ten key research priorities, focusing on sex-specific rehabilitation, injury prevention strategies, and psychological recovery.

This study presents a consensus-driven research agenda to address critical gaps in managing female ACL injuries. These ten priorities will guide future research, enhance clinical outcomes, and promote gender-specific strategies for ACL injury prevention and rehabilitation.