Graft Type and Outcomes After ACL Reconstruction in Female Athletes

This prospective multicenter cohort study aims to compare clinical and functional outcomes between hamstring tendon and quadriceps tendon autografts in anterior cruciate ligament (ACL) reconstruction in female athletes. Participants will be followed for two years after surgery to evaluate graft failure rates, return to sport, knee stability, and patient-reported outcomes.

Inclusion Criteria: * Female patients aged 16 to 35 years with skeletal maturity * Active athlete: minimum two training sessions per week during the six months prior to injury in pivoting sports * Confirmed complete ACL rupture by MRI and clinical examination * Primary ACL reconstruction (first ligament surgery on the index knee) * Time from injury to surgery no longer than 6 months * Signed informed consent Exclusion Criteria: * Previous ligament surgery on either knee * Multiligament injury: simultaneous PCL, grade III MCL or LCL injury * Neuromuscular, rheumatological or systemic pathology interfering with rehabilitation or functional assessments * Pre-existing radiological osteoarthritis grade Kellgren-Lawrence ≥2 in the index knee * Inability to complete 24-month follow-up protocol * Pregnancy at inclusion or during follow-up period