Background

Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries.

Objective

The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science’(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist.

Results

Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4–5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17–1.34), bone stress injury (RR 3.4; 95% CI 2.1–5.4) and concussion (RR 8.46; 95% CI 1.04–68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31–3.88) and hamstring injuries (RR 2.4; 95% CI 1.8–3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37–2.7) to 2.8 (2.45–3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition.

Discussion

Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14–20], tier-4: 16.9 ± 1.9 [11–21], tier-3: 16.9 ± 1.5 [11–20], tier-2: 16.3 ± 2.2 [11–20], tier-1 studies: 15.6 ± 1.3 [14–17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes’ propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes.

Conclusions

Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury.

Trial Registry

PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).

中文翻译：

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不同参与者分类框架下女性和男性运动员受伤情况的差异：系统回顾和荟萃分析

背景

女性是前十字韧带 (ACL) 损伤的重要决定因素。目前尚不清楚性是否是其他运动相关伤害的关键决定因素。

客观的

本次系统评价的目的是确定在六级参与者分类框架中，所有运动项目中性别之间损伤情况差异最明显的地方。

方法

本次系统评价是根据系统评价和荟萃分析的首选报告项目 (PRISMA) 声明和“在运动、康复、运动医学和体育科学中实施 PRISMA”(PERSiST) 指南进行的。从数据库建立到 2023 年 4 月 24 日，对数据库 PubMed、CINAHL、Web of Science、SPORTDiscus、Medline、Scopus、Cochrane Library 和 EBSCO 进行了检索。使用标准损伤数据的纵向、前瞻性和回顾性队列研究以及横断面和描述性流行病学研究收藏被包括在内。如果伤害未经医学诊断并且伤害未按性别报告和/或分析，则研究被排除。两名评审员独立提取数据并使用 Downs 和 Black 检查表评估研究质量。

结果

总体而言，纳入了 180 项研究（8 项 5 级研究、40 项 4 级研究、98 项 3 级研究、30 项 2 级研究、5 项 1 级研究；一项研究包含两级数据）。其中，174 项研究质量中等，6 项研究质量有限。在性别可比较的运动中，有中等证据表明，女运动员膝关节损伤的风险更大（相对风险 (RR) 2.7；95% CI 1.4–5.5）、足/踝关节损伤（RR 1.25；95% CI 1.17–1.34） 、骨应力性损伤（RR 3.4；95% CI 2.1–5.4）和脑震荡（RR 8.46；95% CI 1.04–68.77）均高于男性运动员。与女性相比，男性运动员髋部/腹股沟受伤（RR 2.26；95% CI 1.31–3.88）和腿筋受伤（RR 2.4；95% CI 1.8–3.2）的风险更高，尤其是在动态运动中。男性运动员发生急性骨折的可能性是女性运动员的 1.8 (1.37–2.7) 至 2.8 (2.45–3.24) 倍，且在比赛中风险最高。

讨论

所有队列中的大多数研究质量中等（第 5 级评分平均值/范围：17 ± 2.2 [14–20]，第 4 级评分：16.9 ± 1.9 [11–21]，第 3 级评分：16.9 ± 1.5 [11] –20]，第 2 级研究：16.3 ± 2.2 [11-20]，第 1 级研究：15.6 ± 1.3 [14-17]（唐斯和布莱克清单上的 28 项研究），只有 6 项研究质量有限。女运动员骨应力损伤的倾向凸显了在青春期加强最佳骨骼健康发育和概述能量可用性影响的机会。女性运动员尽早进行力量发展、接受神经肌肉训练计划以及修改技能发展可能是降低下肢受伤风险的有效策略。神经肌肉训练计划的关键组成部分可能有利于降低男性运动员臀部/腹股沟和腿筋受伤的风险。对于女运动员的运动相关脑震荡，可能需要针对性别的预防和重返运动方案。

结论

女性是 ACL 损伤之外的运动相关损伤的关键决定因素，包括足/踝损伤、骨应力损伤和运动相关脑震荡。男性是髋部/腹股沟、腿筋损伤和上肢损伤的关键决定因素。

试验登记处

PROSPERO 注册号：CRD42017058806（最后更新于 2023 年 6 月 7 日）。