{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:53:16Z","timestamp":1792079596380,"version":"4.4.0"},"reference-count":96,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/501100001215","name":"La Trobe University","doi-asserted-by":"publisher","award":["School of Allied Health, Human Services and Sport"],"award-info":[{"award-number":["School of Allied Health, Human Services and Sport"]}],"id":[{"id":"10.13039\/501100001215","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2023,2,26]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Investigate sex\/gender differences in self-reported activity and knee-related outcomes after anterior cruciate ligament (ACL) injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Systematic review with meta-analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>Seven databases were searched in December 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Eligibility criteria<\/jats:title><jats:p>Observational or interventional studies with self-reported activity (including return to sport) or knee-related outcomes after ACL injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 242 studies (n=123\u2009687, 43%\u2009females\/women\/girls, mean age 26 years at surgery). One hundred and six studies contributed to 1 of 35 meta-analyses (n=59\u2009552). After ACL injury\/reconstruction, very low-certainty evidence suggests females\/women\/girls had inferior self-reported activity (ie, return to sport, Tegner Activity Score, Marx Activity Scale) compared with males\/men\/boys on most (88%, 7\/8) meta-analyses. Females\/women\/girls had 23%\u201325% reduced odds of returning to sport within 1-year post-ACL injury\/reconstruction (12 studies, OR 0.76 95%\u2009CI 0.63 to 0.92), 1\u20135 years (45 studies, OR 0.75 95%\u2009CI 0.69 to 0.82) and 5\u201310 years (9 studies, OR 0.77 95%\u2009CI 0.57 to 1.04). Age-stratified analysis (&lt;19 years) suggests female athletes\/girls had 32% reduced odds of returning to sport compared with male athletes\/boys (OR 0.68, 95%\u2009CI 0.41 to 1.13, I<jats:sup>2<\/jats:sup>0.0%). Very low-certainty evidence suggests females\/women\/girls experienced inferior knee-related outcomes (eg, function, quality of life) on many (70%, 19\/27) meta-analyses: standardised mean difference ranging from \u22120.02 (Knee injury and Osteoarthritis Outcome Score, KOOS-activities of daily living, 9 studies, 95%\u2009CI \u22120.05 to 0.02) to \u22120.31 (KOOS-sport and recreation, 7 studies, 95%\u2009CI \u22120.36 to \u20130.26).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Very low-certainty evidence suggests inferior self-reported activity and knee-related outcomes for females\/women\/girls compared with males\/men\/boys after an ACL injury. Future studies should explore factors and design targeted interventions to improve outcomes for females\/women\/girls.<\/jats:p><\/jats:sec><jats:sec><jats:title>PROSPERO registration number<\/jats:title><jats:p>CRD42021205998.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2022-106099","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T18:25:20Z","timestamp":1678299920000},"page":"602-610","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":125,"title":["Let\u2019s talk about sex (and gender) after ACL injury: a systematic review and meta-analysis of self-reported activity and knee-related outcomes"],"prefix":"10.1136","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5422-5756","authenticated-orcid":false,"given":"Andrea 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