ArticleSports health2026
Female Athletes Are Half as Likely to Return to High-Risk Sports Compared With Male Athletes After Anterior Cruciate Ligament Reconstruction: An Exploration of Return-to-Sport Outcomes Between Sexes.
Article in Sports health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDifferences in female and male athletes' return-to-sport (RTS) outcomes after anterior cruciate ligament reconstruction (ACLR) are not well understood. The purpose of this study was to explore sex-based differences in RTS rates and predictors of RTS after ACLR for athletes participating in high-risk sports. HYPOTHESIS: Female athletes will have significantly lower RTS rates than male athletes. STUDY
designSecondary analysis of a randomized clinical trial comparing single-bundle hamstring tendon autograft ACLR with or without a lateral extra-articular tenodesis using the iliotibial band. LEVEL OF EVIDENCE: Level 1.
methodsData from 500 patients who underwent ACLR and participated in high-risk (jumping, pivoting, cutting) sport before injury were included in the study. Three definitions of RTS were created: return to preinjury sport and level, return to any high-risk sport at any level, and return to any sport at any level. Return rates were reported for the overall sample, and separately for male and female athletes. Multivariable logistic regression models were constructed to investigate predictors of each RTS outcome.
resultsApproximately 86.5% of patients returned to any sport, whereas 76.5% returned to a high-risk sport, and only 45.5% returned to their preinjury high-risk sport and level. Male athletes reported consistently higher RTS rates than female athletes. In the final model predicting return to high-risk sport, female athletes had 53% lower odds of returning to high-risk sports compared with male athletes (odds ratio [OR], 0.47; 95% CI, 0.29 to 0.76;
conclusionFemale athletes are less likely to RTS after ACLR compared with their male counterparts; however, this discrepancy appears greatest for athletes returning to high-risk sports. CLINICAL RELEVANCE: Female athletes in high-risk sports may be an important target population for interventions to improve RTS rates after ACLR, and psychological readiness and knee stability may be important treatment targets within this group.
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