Background <p>Bone morphology is a key intrinsic factor in anterior cruciate ligament (ACL) injury. This study aimed to evaluate the impact of femoral notch area (FNA) on functional outcomes after ACL reconstruction (ACLR).</p> Methods <p>This single-center retrospective study was conducted on 68 patients (62 men and 6 women). Data on age, sex, body mass index (BMI), and follow-up duration of patients were recorded. FNA and morphologic measurements were obtained. Patient-reported outcome measures included the International Knee Documentation Committee score (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner Activity Scale (TAS) assessed at a minimum of 24 months postoperatively. The correlation between variables was examined using Spearman correlation, linear, and ordinal regression analyses. A p-value &lt; 0.05 was considered statistically significant.</p> Results <p>The mean age of the patients was 28.9 ± 7.8 years, and the mean follow-up period was 32.2 ± 5.0 (min–max: 25–39) months. A negative correlation was found between BMI and IKDC (<i>r</i> = − 0.363; <i>p</i> = 0.002) and TAS (<i>r</i> = − 0.436; <i>p</i> = 0.001). Statistically significant correlations were found between FNA and IKDC (<i>p</i> = 0.001), KOOS (<i>p</i> = 0.001), and TAS (<i>p</i> = 0.021). ROC analysis identified an FNA cut-off value of 42.2&#xa0;mm² associated with a favourable IKDC outcome (≥ 75.9), although discrimination was modest (AUC = 0.635).</p> Conclusions <p>Femoral notch area was associated with patient-reported outcomes after ACL reconstruction; however, its predictive value was limited. Additionally, an increase in BMI scores negatively impacted patients’ IKDC and TAS scores after ACLR.</p> Level of evidence <p>III, retrospective cohort study.</p>