Males have higher psychological readiness to return to sports than females after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

Abstract

Objectives: To examine sex differences in psychological readiness to return to sport following anterior cruciate ligament (ACL) reconstruction as well as to determine whether males and females separately fulfilled cut-off values (≥65) of psychological readiness necessary to return to sport.

Information sources: Web of Science, Scopus and PubMed were comprehensively searched from inception to January 2024 to identify relevant studies.

Eligibility criteria: Observational investigations that compared males and females with a history of ACL reconstruction concerning psychological readiness to return to sport.

Risk of bias: Studies were rated using the Methodological Index for Non-Randomised Studies.

Included studies: Only 11 reports fulfilled the eligibility criteria and were included in the quantitative analysis. A total of 2618 participants were subjected to the primary ACL reconstruction, out of 1631 males and 987 females. Psychological readiness to return to sport was evaluated approximately 9±2.9 months following surgery.

Synthesis of results: The main findings demonstrated that males had slightly higher psychological readiness to return to the sport than females (standardised mean difference 0.33; 95% CI 0.14 to 0.52; p=0.0007; I²=77%) after ACL surgery. In addition, the mean psychological readiness to return to the sport of males was 70.1±8.8 points and of females 65.1±8.8 points, indicating that both sexes exceeded recommendations necessary to return to sport.

Conclusion: Males had slightly higher psychological readiness to return to sport than females approximately 9±2.9 months after ACL reconstruction and both sexes exceeded the highlighted recommendations necessary to return to sport.

Prospero registration number: CRD42024497769: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024497769.