This 2013 narrative review by Sutton and Bullock synthesizes epidemiologic, anatomic, biomechanical, hormonal, and surgical evidence to characterize why female athletes sustain ACL ruptures at dramatically higher rates than males and how those differences affect prevention strategies, surgical planning, and post-reconstruction outcomes.
When counseling a female athlete after ACL reconstruction, emphasize that her primary re-injury risk is in the contralateral knee — nearly double that of a male — making neuromuscular training during recovery a clinical priority, not just a recommendation.
When planning surgery in a female patient, anticipate a higher likelihood of an A-shaped notch (requiring anteromedial portal drilling for anatomic femoral tunnel placement) and a smaller hamstring graft diameter that may not meet the 8 mm threshold often cited for reconstruction adequacy.
This 2013 narrative review by Sutton and Bullock synthesizes epidemiologic, anatomic, biomechanical, hormonal, and surgical evidence to characterize why female athletes sustain ACL ruptures at dramatically higher rates than males and how those differences affect prevention strategies, surgical planning, and post-reconstruction outcomes.
When counseling a female athlete after ACL reconstruction, emphasize that her primary re-injury risk is in the contralateral knee — nearly double that of a male — making neuromuscular training during recovery a clinical priority, not just a recommendation.
When planning surgery in a female patient, anticipate a higher likelihood of an A-shaped notch (requiring anteromedial portal drilling for anatomic femoral tunnel placement) and a smaller hamstring graft diameter that may not meet the 8 mm threshold often cited for reconstruction adequacy.