Summary
This systematic review showed that most elite female athletes (69%) can return to sports participation following ACLR , however, the information available is insufficient, and there is a lack of quality studies with established criteria
Abstract
Background
Return to sports is considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). In recent years, significant interest has been in the documentation of return to sports following anterior cruciate ligament (ACL) injury. Despite women being at increased risk for ACL injury and global growth in women participating in sports, the female athlete has not been a focus of this research.
Purpose
To conduct a systematic review and meta-analysis to evaluate female athletes' return to sports rate after ACLR.
Methods
A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic databases (PubMed, Embase, and Epistemonikos) were searched for articles reporting a return to sports rates and contextual data in female athletes.
The following search terms were used: “anterior cruciate ligament reconstruction” OR “ACL reconstruction” AND “female” OR “women” AND “return to sports” OR “return to play” to gather all relevant articles between 2003 and 2023. A quality assessment was conducted on included studies.
Results
Fifteen articles were included, reporting on 1457 pivoting sports female athletes.
Included studies consist of 8 cohorts, 2 case-control studies, 2 case series, 2 descriptive epidemiology studies, and 1 observational study. Eleven out of fifteen studies evaluated only elite-level athletes.
Participants had a mean age of 22.75 years (DS 3.40). The most practiced sport among the participants was soccer (55.6% of all athletes included). All 15 studies reported a return to sports rate, showing a meta-proportion of return to the sport of 69% [95% CI, 58-80%]. 9 articles reported time to return to sports, with an average of 10.8 months [95% CI, 8.7-12.8 months].
12 articles described at what level athletes returned to the sport. Tramer, Abed, and Namdari et al. showed worse performance within the first year after surgery, achieving the same pre-injury level after the first year. Brophy, Walden, and Howard et al. described between 75 to 85% of the athletes returning to sports at the same level or higher than the pre-injury level. Lindanger, Ezzat, Mardani-Kivi, Fa¨ltstro¨m, and Myklebust et al. all showed a return to sports to the same pre-injury level between 50 and 59%. Unlike the rest of the articles, Ardern et al. showed a return to the same pre-injury level only in 26% of the participants of the study.
Reasons for not returning to sports were described in 4 studies, being mainly not knee related, as fear of reinjury and changes in the team or training.
Conclusions
This systematic review showed that most elite female athletes (69%) can return to sports participation following ACLR , however, the information available is insufficient, and there is a lack of quality studies with established criteria. Data regarding performance and the level at which they return are missing.