Primary anterior cruciate ligament reconstruction in female athlete-specific literature lacks standardization in outcome reporting : a scoping review

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.