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.