ACL reconstruction: do outcomes differ by sex? A systematic review.

BACKGROUND Anterior cruciate ligament (ACL) reconstruction is frequently performed to restore knee stability and function following ACL injury. Female sex is known to predispose to ACL injury; however, it remains unclear whether female sex predisposes to poor outcomes following ACL reconstruction. We hypothesized that male and female patients exhibit no differences in (1) graft failure risk, (2) contralateral ACL injury risk, (3) knee laxity, and (4) patient-reported outcome scores following ACL reconstruction. METHODS A systematic review of the literature was performed to identify studies in which results of ACL reconstruction were reported by sex at a minimum of two years. Study findings were reviewed, and meta-analysis was performed when data were sufficiently homogenous. RESULTS Thirteen studies were identified from the literature review. Meta-analysis revealed no difference in graft failure risk (eight studies), contralateral ACL rupture risk (three studies), or postoperative knee laxity on physical examination (six studies). There was no evidence of a clinically important difference in patient-reported outcomes according to sex. CONCLUSIONS Results of ACL reconstruction were similar in male and female patients. More high-quality studies are needed to further evaluate these findings.