Optimizing outcomes of anterior cruciate ligament (ACL) reconstruction in female athletes: From graft choice to return to sport criteria

Abstract

Anterior cruciate ligament (ACL) is a common injury in athletes who participate in cutting and pivoting sports. Female athletes have a reported incidence of ACL injury up to nine times more often than their male counterparts in similar sports. ACL reconstruction (ACLR) has high success rates in this patient population, however there are many factors that can increase the risk of re-tear, injury to the contralateral knee, and affect rates of return to sport. Female sex and younger age have been shown to further increase these risks. This article reviews how graft choice, graft diameter, surgical technique, and return to sport criteria can maximize the success of a reconstruction and optimize patient outcomes in the female athlete.