BACKGROUND: Sex disparities in return-to-sport (RTS) outcomes after anterior cruciate ligament reconstruction (ACLR) remain poorly reported. Female athletes may demonstrate higher rates of anterior cruciate ligament (ACL) injuries than male athletes yet exhibit lower RTS rates. PURPOSE: To compare postoperative RTS outcomes between male and female patients after primary ACLR. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic search of the PubMed, MEDLINE, Embase, Scopus, and Web of Science databases was conducted from database inception through September 2025, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies directly comparing RTS outcomes between males and females after primary ACLR with ≥12 months of follow-up were included. Data were synthesized using an exploratory random-effects meta-analysis. Odds ratios with 95% confidence intervals were calculated for dichotomous outcomes, and mean differences for continuous variables. RESULTS: < .001). No significant sex-based differences were observed for RTS to competition or return to preinjury levels. CONCLUSION: Female athletes are significantly less likely to RTS after ACLR during the critical midterm recovery period. These findings highlight the need for sex-specific rehabilitation and psychological support strategies to optimize RTS outcomes in female athletes.
Elliott et al. (Sun,) studied this question.