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Updated: Jun 9, 2026
Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Are There Sex Disparities in Return to Sport After Anterior Cruciate Ligament Reconstruction? A Systematic Review and
Darby Amelia Elliott1, Saran Singh Gill2, Chinmay Madhukar Gupte3
1Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Background:
Sex disparities in return-to-sport (RTS) outcomes after anterior cruciate ligament reconstruction (ACLR) remain poorly reported. Female athletes may demonstrate higher rates of anterior cruciate ligament (ACL) injuries than male athletes yet exhibit lower RTS rates.
Purpose:
To compare postoperative RTS outcomes between male and female patients after primary ACLR.
Study Design:
Systematic review; Level of evidence, 4.
Methods:
A systematic search of the PubMed, MEDLINE, Embase, Scopus, and Web of Science databases was conducted from database inception through September 2025, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies directly comparing RTS outcomes between males and females after primary ACLR with ≥12 months of follow-up were included. Data were synthesized using an exploratory random-effects meta-analysis. Odds ratios with 95% confidence intervals were calculated for dichotomous outcomes, and mean differences for continuous variables.
Results:
In total, 25 studies including 7183 athletes (2892 females, 4291 males) met the inclusion criteria. Female athletes demonstrated significantly lower odds of RTS at 12 months (OR, 0.76; 95% CI, 0.62-0.92; P = .005) and up to and including 24 months (OR, 0.72; 95% CI, 0.61-0.85; P < .001). No significant sex-based differences were observed for RTS to competition or return to preinjury levels.
Conclusion:
Female athletes are significantly less likely to RTS after ACLR during the critical midterm recovery period. These findings highlight the need for sex-specific rehabilitation and psychological support strategies to optimize RTS outcomes in female athletes.