Update on Anterior Cruciate Ligament Rupture and Care in the Female Athlete

Return to sports in female athletes after anterior cruciate ligament reconstruction: A systematic review and metanalysis

IMPORTANCE

Return to sport (RTS) is considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). In recent years, there has been major interest in documenting RTS following anterior cruciate ligament (ACL) injury. Despite women being at increased risk for ACL injuries and a global increase in women's participation in sports, research has not adequately focused on female athletes.

OBJECTIVE

The purpose of this study is to conduct a systematic review and meta-analysis evaluating the RTS rate in female athletes after ACLR. We hypothesize that most of the female athletes can RTS.

EVIDENCE REVIEW

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic databases (PubMed, Embase, and Epistemonikos) were searched for articles reporting RTS 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 retrieve all relevant articles published between 2003 and 2023. A quality assessment of the included studies was conducted.

FINDINGS

Fifteen articles were included, reporting on 1456 female athletes participating in pivoting sports. The included studies comprised 9 cohorts, 1 case-control study, 2 case series, 2 descriptive epidemiology studies, and 1 observational study. Eight out of fifteen studies focused solely on elite-level athletes. The participants had a mean age of 23.13 years. Soccer was the most prevalent sport among the participants, accounting for 49.7% of all athletes included. All 15 studies reported an RTS rate, yielding a meta-proportion of 69% [95% CI, 58-80%] for RTS. Nine articles reported the average time to RTS, which was 10.8 months [95% CI, 8.7-12.8 months].

CONCLUSIONS

This systematic review demonstrates that a majority of female athletes (69 ​%) can RTS participation at an average of 10.8 months, however, the available information is insufficient, and quantitative data and reasons for not returning to play are lacking. Future studies should establish return-to-play criteria in this population and determine reasons for not returning to play.

LEVEL OF EVIDENCE

III.

Common Medical Concerns of the Female Athlete

Women are increasingly participating in more and more sporting activities. For years, women athletes have been treated as the "female" equivalent of male athletes, with similar medical approaches but this is changing. The concept that women are unique in their "athletic arena" is further underscored with emerging scientific evidence--from the physiologic details not visible to the eye, to the more overt biomechanical and anatomic differences. We review a handful of conditions active women potentially may encounter: pregnancy, the female athlete triad, patellofemoral pain, potential injuries to the anterior cruciate ligament, and anemia.

Female athletes: managing risk and maximizing benefit

PURPOSE OF REVIEW

The purpose of this review is to provide an updated summary on the unique aspects of caring for female youth and adolescent athletes.

RECENT FINDINGS

Recent research on female athletes has led to a better understanding of injuries and conditions that are more likely to occur in female youth and adolescent athletes, including the frequency and severity of concussions, musculoskeletal injury such as involving the anterior cruciate ligament, and the female athlete triad. Social factors, such as the growing pressure to specialize in a sport particularly at an early age, also put young female athletes at risk for issues such as overuse injuries. Researchers continue to explore the benefits of athletic participation that extend beyond physical fitness.

SUMMARY

Female participation in youth sports has increased dramatically during the past 50 years. This has led to greater research on how to manage risks and maximize benefits for young female athletes, although there is still much to be learned. Providers should educate patients, parents, and coaches on both the increased risks for female athletes and ways to provide better support and accessibility of youth sports to all children.