ACL Reconstruction Graft Type Influence on Outcomes of Female Soccer Athletes: A Systematic Review

Context: Roughly 29 million women play soccer worldwide, and that number has significantly increased over the past 13 years, especially in the United States. Studies specific to female soccer players and ACL injuries are more prevalent than ever. Female soccer players are roughly 3 times more likely to sustain an ACL injury compared to male soccer players. Anterior cruciate ligament reconstruction (ACLR) is the current solution for most injured patients, ideally resulting in a streamlined recovery and return to sport. Graft type superiority continues to be studied among the female soccer population, but it still remains unclear at this point in time which graft and surgical technique leads to superior patient outcomes. Methods: PubMed and Cochrane databases were accessed using search terms ACL graft choice AND soccer, ACL autograft AND soccer, ACL autograft outcomes AND soccer, and ACL reconstruction AND female soccer. Studies were included if they were written in English, published within the last 5 years, available in full text, included female soccer players undergoing ACLR, and reported outcome measures. The initial search yielded 80 articles leaving 34 articles after removing duplicates. After reviewing titles, 12 articles were removed, leaving 22 articles remaining for abstract review. Following the abstract screening, 12 articles did not meet the study inclusion criteria, leaving 10 articles for full-text review. After 8 full-text articles were eliminated, 2 articles remained in the review. Screening of references included 1 additional article resulting in 3 articles utilized for this study. Results: Three articles were included in the review, combining an identified 225 female soccer players of various ages who underwent ACLR. 15 female soccer players had their ACLR procedure done with the quadriceps tendon (QT), 66 bone-patellar tendon-bone (BPTB), and 144 hamstring tendons (HS). PROs measured were the International Knee Documentation Committee (IKDC), Lysholm Knee Scoring Scale (LKSS), and Tegner Activity Scale (TAS). Other outcome measures compared were the average follow-up after ACLR, RTS, and complications post ACLR. Conclusions: Evidence suggests that female soccer players with ACLR have a low RTS rate, a high chance of developing further knee conditions and complications, acceptable LKSS and LDKC scores average, and a low TAS average. Female soccer players who were included in this review had a 53.3% chance of returning to sport after ACLR. The collected RTS data suggests that nearly half of female soccer players are struggling to return to the pitch. High complication rates were noted, stating that female soccer players have a 54.7% likeliness of developing further knee conditions and injuries.