Primary anterior cruciate ligament reconstruction in female athlete-specific literature lacks standardization in outcome reporting

Abstract

Aims

Female athletes sustain anterior cruciate ligament (ACL) ruptures at higher rates than male athletes. There is limited literature focusing on outcomes after ACL reconstruction (ACLR) in this population. The purpose of this study was to conduct a scoping review into female-specific literature for primary ACLR procedure, and to ascertain the variability in reporting outcomes in the literature. ‘Female’ was defined as sex assigned at birth for the purposes of this study.

Methods

The systematic review was conducted according to PRISMA, and also used Arksey and O’Malley’s established five-stage process for scoping reviews to map the literature for primary ACLR in female-specific literature. After screening, data were extracted and mapped to provide a descriptive and thematic analysis.

Results

A total of 1,172 studies were identified from the initial search with 16 studies eligible for final scoping review published from 2004 to 2024. Studies were identified from eight countries, with 9/16 (56.3%) from the USA. The mean age was 23.4 years (16 to 32). Key variables such as graft type (7/16, 43.8%) and graft diameter (2/16, 12.5%) were significantly under-reported. Of the functional outcomes, Tegner Activity Score was reported in seven studies (7/16, 43.8%), the International Knee Documentation Committee Score (IKDC) in six studies (6/16, 37.5%), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) in six studies (6/16, 37.5%). Overall, 25 clinical outcomes were recorded spanning all studies including graft re-rupture (4/16, 25.0%), Lachman’s score (3/16, 18.8%), pivot shift (4/16, 25.0%), and return to sport (5/16, 31.3%).

Conclusion

This review identified 16 studies which analyzed female-specific literature for primary ACLR over the last 20 years. There is a significant lack of studies in the literature reporting on female-specific outcomes, and in the eligible studies, there was a significant lack of standardization of variable and outcome reporting.

Cite this article: Bone Jt Open 2026;7(5):692–703.

Introduction

Approximately 400,000 anterior cruciate ligament (ACL) reconstructions (ACLR) occur in the USA every year, with this injury being three to eight times higher in the female population compared with males.^1-4 Furthermore, the risk of re-rupture and revision surgery in the female population is also higher.⁵ With the rate of female participation in both recreational and college sports expected to rise, and with the significant investment in female professional sport, this discrepancy in rate of injury is likely to amplify.⁶

Sex discrepancies in the incidence of ACL injury, clinical outcomes, complication, and revision rates following reconstruction in the female athlete are not completely understood. Several factors have been proposed as being contributory to these discrepancies, including anatomical, biomechanical, endocrine, and sport-specific.^7,8 Anatomical factors that may increase risk of re-rupture include a higher Q-angle, smaller femoral notch, increased tibial torsion, increased posterior tibial slope, quadriceps dominance, diameter of hamstrings tendons, and collagen content of tendons. Literature also reports a significant impact on landing mechanics leading to poorer postural control and dynamic knee valgus on landing, thereby increasing strain on the native ACL.^9,10 Additionally, more attention has been paid recently to hormonal variations as a result of the menstrual cycle and their effects on injury rates.¹¹ Furthermore, the cyclical variations in the hormones progesterone, oestrogen, and relaxin have been shown to have an effect on ACL metabolism, particularly during days 21 to 24 of the menstrual cycle, representing a time of increased ACL injury risk.¹² Certain sports may represent an added risk, with contact sports such as soccer and netball representing a particular risk,¹³ in comparison to sports such as lacrosse.¹⁴

Despite the recognized issues and rising concern of ACL injuries in female athletes, a recent study highlighted that annual publication of female-specific studies was around eight times less than that of male publications in sports science and in the sports medicine literature.¹⁵ Additionally, as a result of the aforementioned higher risks and complications surrounding female ACL injuries, it is important to consider females as a distinct group from males. The aim of this study is to provide a methodologically robust scoping review to map the available literature surrounding female-only studies in primary ACLR, adding to the focus on female-specific literature. This review should further inform evidence-based practice, and systematically identify the gaps in reporting criteria.

Methods

The five-stage scoping review process proposed by Arksey and O’Malley¹⁶ was adopted, with the recommended adaptations by the Joanna Briggs Institute incorporated.¹⁷ This protocol has been previously published by Makaram et al.¹⁸ This study was conducted in line with the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines.¹⁹ The five-stage process was conducted as follows:

Stage 1: Determining the research question

The authors aimed for a broad research question in order to capture as much data as possible in relation to the aim. Therefore, the research question formulated was: what studies have been published with regard to female-specific outcomes in primary ACLR? This would allow capture of the population, variables, and outcomes required to address the aim of the study.

Stage 2: Identifying relevant studies

For this scoping review, the term ‘female’ related to sex assigned at birth. Inclusion and exclusion criteria to delineate eligible studies is summarized in Table I. MEDLINE via PubMed was searched from inception to 1 August 2024. Grey literature sources such as OpenGrey were reviewed, but did not yield any relevant results. Additional articles were sought by reviewing the reference lists on applicable articles. The following medical subject headings (MeSH) and terms were used in our search strategy: (acl) OR (anterior cruciate ligament) AND ((repair) OR (reconstruction)) and ((outcome) OR (measure) OR (strength) OR (stability) OR (range of motion)) AND ((female) OR (girl) OR (female population)). Studies were limited to the English language. A PRISMA flow diagram is presented in Figure 1. After removal of duplicates, three authors (BG, JS, KAH) independently screened the remaining titles and abstracts against the earlier defined eligibility criteria. Differences were resolved by consensus.

Table I.

Study inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
Anterior cruciate ligament tears	Individual case reports, opinion pieces, and narrative reviews
Studies involving skeletally mature (aged 16 years) patients only	Studies including paediatric patients (aged < 16, skeletally immature)
Studies involving female athletes only	Studies including male athletic population
	Studies not describing outcomes of operative management
	Studies written in a primary language other than English

Fig. 1.

PRISMA diagram for study selection.

Stage 3: Study selection

After removal of duplicates, two authors (BG, JS) independently screened the remaining titles and abstracts against the earlier defined eligibility criteria. A third senior reviewer (KAH) then completed the screening process with a random selection of 10% of the articles remaining after initial duplicates were removed in order to validate concordance with the inclusion/exclusion decision making. Differences were resolved by consensus after full-text review.

Stage 4: Charting the data

Data were extracted and tabulated by two reviewers (BG, JS), who analyzed all included studies. Data from each study were charted and these were tabulated into both a priori categories and emerging themes to include: study characteristics (study type, level of evidence, country, and year), patient demographic details, variables reported (including data on graft type, cost, processing, sterilization, and storage), and outcomes reported (functional and clinical) (Table II). This was charted into a heat map (Figure 2) for ease of analysis and to give a gross impression of the results. Any discrepancies were resolved via consensus following consultation with a senior author (KAH), who also checked > 10% (4/35) of the eligible articles for accuracy of data extraction. Accuracy was confirmed by reviewing the article and confirming that all data points measured in each study were included in the heatmap created to track outcome variables.

Table II.

Variables which may critically influence outcomes that were collected in the assessment of reporting standards.

Study design:

Study conducted in accordance with CONSORT, STROBE, or PRISMA guidelines

Patient-based details:

Age

BMI

Laterality

Activity or competition level

Prior injury to knee

Injury management details:

Timing from injury to surgery

Length of follow-up postoperatively

Associated injury to ipsilateral knee

Activity during injury

Use of physical therapy prior to ACL repair

Graft type

Graft size

Repair technique

Concomitant treatment of meniscal injury

Secondary outcome measure - Quality of reporting of clinical and patient -reported outcomes following management of ACL tear in female athletes:

Clinical outcomes described:

Reinjury or retear

Failure method

Time to failure

Reoperation rate

Osteoarthritis on postoperative radiograph

Lachman’s test

Pivot shift test

KT-2000 Stress test

Pain with acitivity

Pain with kneeling

Active position sense accuracy

Dynamic position sense

Reaction time

Passive position sense accuary

EMG

Ankle dorsiflexion

Hip and knee mechanics during jumping

Tibiofemoral compressive force

Muscle forces at compression

Isokinetic strength

Goniometric flexion angle

One leg rise

Triple single leg hop

Return to sport

Time to return to sport

Patient-reported outcome measures described:

Tegner activity store

IKDC scores

Lysholm scores

KOOS scores

Kujala scores

VAS

KSES score

ACL-RSI score

TSK-11 score

Joint laxity

Marx activity score

SF36

Patient satisfaction rate

ACL, anterior cruciate ligament; ACL-RSI, anterior cruciate ligament return to sport after injury; EMG, electromyography; IKDC, International Knee Documentation Committee; KOOS, Knee Injury and Osteoarthritis Outcome Score; KSES, Knee Self-Efficacy Scale; STROBE, Strengthening the Reporting of Observational Studies in Epidemiology; TSK-11, Tampa Scale of Kinesiophobia-11; VAS, visual analogue scale.

Fig. 2.

Heatmap demonstrating data reported in each study, stratified into patient demographic details, variables reported, and outcomes reported. ACL-RSI, anterior cruciate ligament-return to sport after injury; EMG, electromyography; IKDC, International Knee Documentation Committee; KOOS, Knee Injury and Osteoarthritis Outcome Score; KSES, Knee Self-Efficacy Scale; OA, osteoarthritis; PT, physical therapy; RTS, return to sports; SF-36, 36-Item Short-Form Health Survey questionnaire; TSK-11, Tampa Scale of Kinesiophobia-11; VAS, visual analogue scale; WNBA, Women’s National Basketball Association; XR, X-ray.

Stage 5: Collating, summarizing, and reporting results

Analysis and summarization of data was grouped into two domains: the first was descriptive analysis, outlining basic data pertaining to study characteristics as outlined in stage 4. The second domain was thematic summary, as per the a priori categories in stage 4 and their relation to the aim of the study and the broad research question posed in stage 1. These were mapped out accordingly into four main themes: 1) patient demographic details; 2) study independent variables; 3) patient-reported outcomes; and 4) clinical outcome reporting (Figure 2).

Results

Descriptive analysis

The screening process is outlined in Figure 1. A total of 1,172 studies were identified from two different databases (MEDLINE and PubMed). From these, 35 studies were isolated after removing duplicates, and were screened using a title and abstract keyword search, through which 1,137 studies were excluded due to not meeting the inclusion criteria. The remaining 35 studies were then subjected to full-text screening, 19 of which were excluded for reasons such as irrelevance, language, and lack of full-text accessibility. Following the screening process, 16 studies were identified as eligible to be included in final analysis. A summary of each study can be found in Table III.

Table III.

Full-text articles eligible for final analysis.

Authors	Journal	Year	LOE	Country	Study design	Objective
Namdari et al20	The Physician and Sports Medicine	2011	3	USA	Cohort	To compare athletes who underwent ACL reconstruction with pre-injury and matched controls to determine differences in performance and return to play.
Shakked et al21	Journal of Knee Surgery	2017	3	USA	Cohort	To evaluate patient-reported outcomes, objective knee stability, complication rates, and the incidence of failure after ACL reconstruction using bone–patellar tendon–bone autograft compared with hamstring autograft in young female patients.
Littmann et al22	Journal of Sport Rehabilitation	2012	4	USA	Cross-sectional	To compare proprioception of knee movement in women with ACLR and healthy controls.
Stanley et al23	Research in Sports Medicine	2019	3	USA	Cohort	To examine associations between ankle dorsiflexion displacement and knee and hip kinematics and kinetics during a jump-landing task in females following anterior cruciate ligament reconstruction.
Tsai et al24	American Journal of Sports Medicine	2013	4	USA	Controlled laboratory study	To examine whether muscle co-contraction and tibiofemoral compressive forces in females after undergoing ACLR can be reduced through the use of a landing strategy that emphasizes greater hip and knee flexion.
Briem et al25	Knee Surgery, Sports Traumatology, Arthroscopy	2016	3	Iceland	Cohort	To assess activation patterns of medial versus lateral hamstrings in female athletes who had undergone ACL reconstruction using a hamstrings-graft during single-limb functional testing.
Vairo et al26	Arthroscopy: The journal of arthroscopic and related surgery	2013	4	USA	Therapeutic study, case series	1) To profile the standing flexion angle and its association with subjective outcomes in ipsilateral hamstring tendon autograft anterior cruciate ligament reconstructed patients. 2) To describe prone position measured hamstring strength as a predictor of flexion angle.
Guzzini et al27	International Orthopedics	2016	3	Italy	Cohort	To report subjective and objective outcomes after combined ACL and lateral extra-articular tenodesis with a minimum 4-year follow-up in a selected high-risk population of elite female football players.
Hill et al28	American Journal of Sports Medicine	2005	2	Australia	RCT	To determine whether reinforcement of the tibial fixation would reduce the increased laxity seen in female patients undergoing ACL reconstruction using hamstring tendon graft.
Lohmander et al29	Arthritis and Rheumatism	2004	3	Sweden	Cohort	To determine the prevalence of radiological knee osteoarthritis as well as knee-related symptoms and functional limitations in female soccer players 12 years after an anterior cruciate ligament injury.
Tiplady et al30	American Journal of Sports Medicine	2023	2	New Zealand	Cohort	To assess the effect of graft choice on ACL reconstruction failure rates among young women in New Zealand.
Ezzat et al31	American Journal of Sports Medicine	2021	3	Canada	Cohort	1) To assess whether female youth and young adults who have had ACLR in the previous 1 to 2 years would have less moderate or vigorous physical activity compared with healthy matched controls. 2) To assess if the ACLR group would report lower levels of sports participation, patient-reported health outcomes, and physical function.
Allen et al32	American Journal of Sports Medicine	2016	3	USA	Cohort	To 1) report the rates of subsequent ACL injury (ipsilateral graft rupture or contralateral tear) in competitive female soccer players; 2) compare these rates with those of other female athletes of similar competitive level; 3) determine risk factors for second ACL injury; and 4) report clinical outcome scores in this population.
Lee et al33	Orthopaedic Journal of Sports Medicine	2023	3	South Korea	Cohort	To evaluate the results of combined ACLR and anterolateral ligament reconstruction in young females with a high-grade pivot shift (grade 2).
Tramer et al34	Orthopaedic Journal of Sports Medicine	2020	3	USA	Cohort	To quantify RTP rates and performance after ACL reconstruction in WNBA athletes.
Zarzycki et al35	Sports Health	2024	3	USA	Secondary analysis of RCT	To assess whether greater kinesiophobia, less knee confidence, and lower psychological readiness would be associated with second ACL injury.

ACL, anterior cruciate ligament; ACLR, anterior cruciate ligament reconstruction; LOE, level of evidence; RCT, randomized controlled trial; RTP, return to play; WNBA, Women's National Basketball Association.

The distribution of the 16 studies by the year of publication can be seen in Figure 3. The studies span from 2004 to 2024, with all articles published in the last 20 years, and 10/16 (62.5%) published in the last ten years.

Fig. 3.

Number of publications per year reporting on primary anterior cruciate ligament reconstruction in females.

Studies were identified from eight countries, with 9/16 (56.3%) from the USA and the remaining 7/16 (43.7%) from other countries, including Australia, Republic of Korea, Canada, Iceland, Italy, New Zealand, and Sweden.

The type of sport studied in the included studies is outlined in Figure 4. Two studies (2/16, 12.5%) analyzed more than one sport. The most frequently analyzed sports were soccer and basketball (4/16 studies for each, 25.0%); volleyball and handball were assessed in separate studies (1/16, 6.25%). Eight studies did not assess type of sport (8/16, 50.0%).

Fig. 4.

Type of sport reported in studies reporting on primary anterior cruciate ligament reconstruction in females.

The classification of the included studies is outlined in Figure 5. Out of the included studies, 15/16 (93.75%) were primary studies and 1/16 (6.25%) was a secondary study. Of the primary studies, 9/16 (56.25%) were cohort studies, 2/16 (12.5%) were case-control studies, 1/16 (6.25%) was a randomized controlled trial (RCT), 2/16 (12.5%) were cross-sectional studies, and 1/16 (6.25%) was a controlled laboratory study. The single secondary study was a secondary analysis of a prospective randomized trial.

Fig. 5.

Type of study reporting on primary anterior cruciate ligament reconstruction in females. RCT, randomized controlled trial.

Level of evidence (LoE) was determined in accordance with the Oxford Centre for Evidence Based Medicine Levels of Evidence.³⁶ The distribution of studies by LoE can be seen in Figure 6. There were 2/16 (12.5%) studies at level II evidence, 11/16 (68.75%) at level III, and 3/16 (18.75%) at level IV.

Fig. 6.

Level of evidence for studies reporting on primary anterior cruciate ligament reconstruction in females.

Given the heterogeneity in study parameters as described above, and the remit of this scoping review, no formal quality assessment of the studies was attempted, as this fell outside the remit of the aim and broad research question.

Thematic analysis

A representative heatmap for patient demographic details is shown in Figure 2. The sample size of female patients with ACLR ranged from 10 to 180. The most frequently reported demographic characteristics were participant age and BMI, documented in 14/16 and 10/16 studies, respectively. The range of patient age was 16 to 32 years, with 14/16 studies including patient age with a mean age of 23.4 years. The mechanism of injury and activity during injury was rarely reported, with both metrics being recorded in 3/16 (18.8%) studies. Details on prior knee injury reported in 1/16 studies (6.25%) were largely excluded. BMI was noted in 10/16 studies (62.5%), and height and weight were reported in 5/16 (31.3%) and 6/16 (37.%) studies, respectively.

The most commonly reported independent study variable with patient demographic details was the type of graft used for primary ACLR with 7/16 studies (43.8%). Two of these studies analyzed one graft type (2/16, 12.5%), with the remaining five studies analyzing more than one graft type (5/16, 31.3%). A total of 1,677 patients had graft type reported: the majority underwent hamstrings autograft (1,007/1,677, 60.0%), followed by BTB autograft (562/1,677, 33.5%), with the remainder being allograft reconstruction (108/1,677, 6.5%). In comparison, another important graft characteristic, namely graft diameter, was only reported in 2/16 studies (12.5%).

A total of 13 functional outcomes were reported across the studies. The most commonly reported outcomes were patient-reported outcome measures, namely the Tegner Activity Score in seven studies (7/16, 43.8%),³⁷ the International Knee Documentation Committee Score (IKDC) in six studies (6/16, 37.5%),³⁸ and the Knee Injury and Osteoarthritis Outcome Score (KOOS) score also in six studies (6/16, 37.5%).³⁹ There were no functional outcomes reported in three studies (3/16, 18.8%).

In total, 25 clinical outcomes were recorded across the studies. Clinical outcomes were widely under-reported. This includes graft re-rupture (4/16, 25.0%), Lachman’s score (3/16, 18.8%), pivot shift (4/16, 25.0%), and return to sport (5/16, 31.3%).

Discussion

This scoping review is the first to thematically and descriptively assess reporting standards for female athlete-specific primary ACLR literature. Additionally, it has mapped out the breadth of reporting standards and ascertained the variability in the reporting of key variables and outcomes. To the best of the authors’ knowledge, this is the first scoping review to assess this aim.

Clinical variables

While this scoping review has served to highlight the deficiency in key reporting outcomes, it is important to assess key clinical and functional variables. In this review, it was observed that just under half the studies in the literature reported on type of graft used. In a New Zealand ACL registry study by Tiplady et al,³⁰ data were prospectively captured on 1,261 primary ACLRs in young females between 2014 and 2022, noting a higher rate of hamstrings autograft use (63%), compared with bone-patellar tendon-bone graft (37%), with a subsequent higher failure rate seen in the hamstrings group (7.7% vs 1.1%). A further 2023 study by Zarzycki et al³⁵ analyzed 39 high-level female athletes and their psychological readiness for return to sport; 18 female athletes underwent hamstrings soft-tissue autograft, 16 bone-patellar tendon-bone (BTB) autograft, and five patients underwent allograft reconstruction. Nine patients sustained a re-rupture of their graft within two years, all of whom underwent hamstrings autograft reconstruction. It was noted that these patients had an earlier return to sports and psychological readiness to return, and it was recommended that those female athletes who display earlier psychological readiness to return to sport should be delayed. Furthermore, a key graft characteristic, namely graft diameter, was only reported in two studies. Tiplady et al³⁰ noted a mean BTB autograft diameter of 9.8 mm, with mean hamstrings autograft of 8.1 mm. In the only other study recording graft diameter, Hill et al²⁸ observed a median diameter of hamstrings tendon autograft of 7.5 mm (6.5 to 8), in a study of 56 females assessing supplementary tibial fixation on outcomes. There was a discernible paucity in the reporting of other independent study variables (Figure 2).

Clinical and functional outcomes

The three most commonly reported functional outcomes, namely Tegner, IKDC, and KOOS, were also reported in under half the studies included. Littmann et al²² assessed 11 females who had undergone ACLR compared to 20 who had not. In a comprehensive assessment of patient-reported function, while there was no difference in Tegner activity score between the groups, there was a clear, significantly lower IKDC score in those who had undergone ACLR. Additionally, in particular domains of the KOOS score (pain, quality of life, symptoms, and sport/recreation), there was a significantly lower score noted in those who had undergone ACLR compared with controls. This was also backed by a larger study of 180 female ACLR patients who were compared with athletes of a similar competitive level, and noted no difference in IKDC or Tegner scores at latest follow-up.³² Briem et al²⁵ compared 18 ACLR female patients with 18 control patients and only found a lower KOOS score for the symptoms sub-scale at latest six-year follow-up. Vairo et al²⁶ compared 15 hamstring autograft ACLR female patients with 15 healthy controls, and noted a lower KOOS for the pain and sports/recreation sub-scales, supporting the work by Littmann et al.²² Shakked et al²¹ assessed 66 young female patients (aged 15 to 25 years), 37 of whom underwent BTB autograft ACLR, and 28 hamstrings autograft ACLR. While there was a lower graft re-rupture rate noted in the BTB group, there was no significant difference noted in Tegner or IKDC scores. The KOOS score was not assessed.²¹

Of the 25 clinical outcomes reported, those of graft re-rupture, Lachman’s score, pivot shift, and return to sport were reported in under one-third of all included studies. Hill et al²⁸ randomized 56 female patients undergoing hamstrings autograft ACLR into two groups, to assess whether supplementary fixation of the graft on the tibial side (staple) led to an effect on outcomes. At two-year follow-up, a significant difference favoured the supplementary tibial fixation group for Lachman’s grading, but no difference between the groups was noted for pivot shift grade.²⁸ All studies included which assessed graft re-rupture rate favoured BTB autograft ACLR over hamstrings autograft ACLR, with this being most pronounced in the national New Zealand registry study by Tiplady et al,³⁰ as described earlier.

The main message of this scoping review is the considerable lack of reporting and, when reporting is available, the lack of standardized reporting for variables and outcomes in female-specific ACLR literature. Scoping reviews are designed to identify the types of available evidence in a given field, identify the key characteristics related to the concept at hand, highlight potential knowledge gaps, clarify concepts in the literature, and provide a precursor to systematic reviews.⁴⁰ This is particularly important in female-specific literature in recognition of the significant differences in both ACL injury rates, as well as postoperative complications. Subsequently, considering female ACL injuries as a separate entity to males is important, as this will advance our understanding of sex differences and, consequently, outcomes for this patient group.

We acknowledge that our decision to focus solely on female athletes may be seen as a limitation, as there is a similar dearth of articles that focus on male athletes. Though many of the larger studies on outcomes after ACLR feature both sexes, the female sex is often less represented as a percentage of the study population, and is consistently found to be a predictor of worse outcomes.^41-45 We hope to highlight the lack of female athlete-specific outcome studies, not to suggest that they are more important than outcome studies in male athletes, but rather to further investigate a population that historically has worse outcomes after ACLR in an attempt to understand why.

Additionally, this scoping review employed rigorous methodology in order to map the data, identify gaps in the literature, and highlight controversies regarding this issue in primary ACLR surgery for female-specific literature. This is a novel study providing a broad and contextual overview of the literature regardless of the quality, encompassing studies since inception. While the review is not designed to analyze data subsets statistically, it is clear that there would be risk of a lack of granularity in reporting variables and outcomes to enable a robust systematic review and meta-analysis. There would also be a significant risk of data heterogeneity. For the purposes of this scoping review, ‘female’ was defined as sex assigned at birth. While the authors did not encounter any studies which highlighted any transgender patients, or those who had undergone hormonal treatment/sex reassignment surgery, it is important to note that this may need to be a consideration in the future.

Future research priorities

Given the main message of this scoping review with regard to lack of standardized reporting, there is clearly a need for standardization of reporting criteria for female-specific studies looking at primary ligament injuries around the knee. This would enable greater comparison of data in the future, and allow more robust conclusions to be drawn from any meta-analysis. Relevant data should be standard in ACLR outcome literature, including age, height/weight/BMI, and notch width (demographic data), time from injury to operation, graft type, graft size, and meniscal treatment (operative criteria), IKDC and KOOS (patient-reported outcome measures), re-rupture rate, time to failure, and return to sport rates (clinical outcomes). The authors of this paper suggest the need for further discussion regarding the most relevant reporting criteria through an international consensus statement of experts in order to accurately assess the future validity of studies. There is a clear need for a drive for female-specific studies to be conducted in the future, in order to truly assess the impact this injury has on this sub-group of patients and their outcomes, as current literature is heavily biased towards males.⁴⁶

In conclusion, this scoping review identified 16 studies which analyzed specific outcomes in female athletes after primary ACLR. There is a significant lack of studies in the literature reporting on female-specific outcomes, and in those studies eligible for the scoping review, there was a significant lack of standardization of variable and outcome reporting. Further research is required to develop standardized reporting criteria in order to accurately reflect the outcomes of primary ACLR in female athletes.

Take home message

- Anterior cruciate ligament outcomes research that focuses on female athletes lacks standardized outcome variables.

- By highlighting the gaps and inconsistencies in data reporting, we hope to work towards developing a more unified approach to outcomes reporting in this population.

Data Availability

The data that support the findings for this study are available to other researchers from the corresponding author upon reasonable request.