Sex‐related differences after ACL reconstruction differ between early functional recovery and 5‐year outcomes
Knee Surgery Sports Traumatology Arthroscopy · 15 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
It shows that a similar 'return to sport' rate can hide a real sex gap in returning to the same level of activity after ACLR, which matters when counselling female athletes.
The evidence
This single-centre retrospective cohort compared 479 patients (173 women, 306 men) after primary hamstring ACL reconstruction, looking at 6-month strength and hop testing and 5-year sport and patient-reported outcomes. Women had weaker quadriceps symmetry and larger hop deficits at 6 months, and at 5 years only 28.1% of women versus 45.1% of men returned to their preinjury Tegner level, even though overall return-to-sport rates were similar (59.5% vs 61.2%). After adjusting for baseline factors, male sex was associated with roughly double the odds of regaining preinjury activity level (OR 2.16, 95% CI 1.40 to 3.39).
Recovery of preinjury activity level at 5 years (post-operative Tegner >= preoperative Tegner): Odds ratio 2.16 (95% CI 1.4 to 3.39; Tegner). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Retrospective cohortDesign starting point: 29.6
Raised the score
- 60-month follow-up+3.4
- Aligned time zero+2.5
Lowered the score
- Cases were selected rather than consecutive−5.1
- A single centre's own patients−3.4
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 29.6
- Aligned time zero
- +2.5
- 60-month follow-up
- +3.4
- A single centre's own patients
- −3.4
- Cases were selected rather than consecutive
- −5.1
- Journal prior (not an observed method)
- +1
- Final rigour score rounded
- 28 / 100
Study design sets the starting point and a ceiling of 72. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Should rehabilitation targets or return-to-sport clearance criteria after ACLR be adjusted for women, given their larger hop and quadriceps deficits at 6 months?
2.How should you counsel a young female athlete about the difference between returning to any sport and returning to her preinjury level after ACL reconstruction?
Original publication title
Sex‐related differences after ACL reconstruction differ between early functional recovery and 5‐year outcomes