Sports Injuries in Female and Non-Binary Athletes: A Systematic Review

Abstract

Purpose of Review

The main purpose of this review was to summarize the current evidence on treatment and outcomes of sports injuries requiring surgical intervention in female and non-binary athletes and identify key gaps in the related literature concerning sports injuries requiring surgical intervention to guide future research.

Recent Findings

Of the 59 included studies, all focused on biological sex or sex-based differences, while none of the studies discussed gender or the inclusion of non-binary and transgender individuals. Most of the studies (47/59, 80%) focused on ACL reconstruction (37%), hip arthroscopy (27%) or rotator cuff repair (15%). Important sex-based differences were seen with these injuries including differences in fears regarding recovery after ACL injury and pre- and post-operative pain scores following rotator cuff injury.

Summary

Despite increasing recognition of the role of biologic sex in the treatment and outcomes of sports injuries, very little is known about the impact of gender in sports injuries. Previous sociological literature suggests that gender may play an important role in one’s athletic experience, and thus their injury experience. With most of the included studies focused on only three injury types, the experiences of female and non-binary athletes with all other sports injuries are poorly characterized. The lack of gender-inclusive sports injuries research means that the complete experiences of female, non-binary and transgender athletes are not comprehensively captured in the current literature. Future research should aim to characterize the effect of gender on the treatment and outcomes on all sport-related injuries, with the goal of providing inclusive surgical care for all athletes.

Introduction

Over the past two decades, there has been increasing understanding that some sports injuries are more common in female athletes than male athletes. The differences in the incidence of certain injuries have historically been attributed to sex-based differences of the musculoskeletal system, with female bodies being predisposed to certain injury patterns due to anatomic and physiologic differences [1, 2]. For example, sex differences in the incidence of anterior cruciate ligament (ACL) rupture have been well reported. Female athletes are at a 4–6 times greater risk of sustaining an ACL injury compared to male athletes, are less likely to undergo ACL reconstruction, are less likely to return to their pre-injury level of sport, and have poorer patient reported outcomes following reconstruction [3–6]. It has been hypothesized that these differences can at least in part be attributed to female athletes having smaller notch dimensions, increased Q angle, and increased ligamentous laxity compared to male athletes [7, 8]. Similar physiologic explanations have been proposed for sex differences observed in the incidence of femoracetabular impingement, shoulder instability, and concussion [9, 10].

The Canadian Institutes of Health Research defines sex as a set of biological attributes, including chromosomes, gene expression, hormone levels and function, and reproductive anatomy [11]. Gender describes a set of socially constructed roles, behaviours, and expressions [11]. Sex is typically categorized as male, female or intersex, while gender exists on a continuum. Many extrinsic factors associated with sports participation and injuries vary by gender, suggesting that gender is an important factor to investigate in the development and treatment of sports injuries in addition to sex. For example, body image and self-esteem issues are more prevalent in young girls/women which can impact their nutrition, training and participation in sport [12, 13]. Historically, women have identified concerns over participation in strength and conditioning programming due to fears of “bulking up” and gaining weight [14]. However, these strength and conditioning programs have been shown to decrease the risk of injury, especially knee injuries which tend to occur more commonly in female athletes. Gender also plays a significant role in shaping an individual’s athletic identity, and has been shown to impact injury experience [15, 16]. This illustrates the importance of performing gender-based analyses in sports injuries to better understand the differences that exist and develop effective prevention and treatment strategies.

Limited existing evidence indicates significant health inequalities between non-binary individuals and their cisgender peers [17]. Since extrinsic factors, such as social support, have a known impact on the incidence and outcomes of sports injuries, it is likely that non-binary and transgender individuals have different injury experiences compared to cisgender individuals. Non-binary individuals have reported negativity and policy barriers regarding their participation in sport, discomfort in the locker room and body incongruence, all factors which may impact their risk of injury [18]. Furthermore, the effect of exogenous hormone therapy may impact bone health, leading to an increased risk of stress fracture in transwomen [19]. These considerations for non-binary athletes emphasizes the importance of gender as a consideration in the development, treatment and outcomes of sports injuries.

Most sports injury research focuses on athletes assigned male at birth, with more recent research considering athletes assigned female at birth and related sex differences. Very little research in this field considers gender identity, and thus the impact of gender on the incidence, treatment and outcomes of sports injuries is not well understood. As such, the objectives of this systematic review were to (1) summarize the current evidence on treatment and outcomes of sports injuries requiring surgical intervention among female and non-binary athletes, (2) outline the inclusion of gender, rather than sex, in current sports injury research, and (3) identify key gaps in the literature concerning sports injuries requiring surgical intervention among female and non-binary athletes to guide future research.

Methods

This systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extended guidelines for conducting and reporting systematic reviews [20].

Search Strategy

A comprehensive search of three databases (MEDLINE, EMBASE and PubMed) was performed on July 18, 2024, for all studies published in the past 5 years. Broad search criteria were used to identify eligible studies including the search terms “sports injur$”, “arthroscop$”, “athletic injur$”, “sex”, “gender”, “female” and “non-binary” (Appendix 1).

Study Screening

Studies resulting from the search were screened by title and abstract, then full-text by two independent reviewers in duplicate using Rayyan [21]. Disagreements during the title and abstract stage were carried forward to the full-text screening stage. After full-text screening, all discrepancies were resolved by a third senior author. The references of all studies included in the full-text review were manually searched and the PubMed “related articles” feature was used until saturation to ensure a comprehensive search (Fig. 1).

Fig. 1.

PRISMA Diagram

Eligibility Criteria

Studies were included if they met the following criteria: (1) the study included female or non-binary patients only OR the primary objective of the study was to assess sex- or gender-related differences; (2) the study focused on one or more sports injuries for which surgical intervention may be required as defined by Pellarin et al. [22]; (3) English language; (4) human study; and (5) therapeutic studies of all levels of evidence. Exclusion criteria included any studies that (1) focused on head injuries or concussions; (2) focused on imaging; (3) focused on injury prevention; (4) assessed sex and gender differences via subgroup analysis; (5) reviews; (6) technical guides; and (7) case series/reports with < 5 patients. Studies which assess sex and gender differences via subgroup analysis were excluded as subgroup analyses are often underpowered and involve multiple testing which increases the likelihood of type 1 error.

Data Abstraction

Relevant data from included articles was abstracted into an online shared spreadsheet (Google Sheets, 2024. California, USA: Google LLC). This spreadsheet feasibility and accuracy of data collection was piloted initially with 5 studies. The first 5 studies were abstracted in duplicate by two independent reviewers (AA and LM) to ensure agreement before completing the remainder of the data set. All remaining data was abstracted independently, but random spot checks were performed by a senior author (LAG) to ensure accuracy. Data was collected on study characteristics, participant demographic data, study objectives, and sport injury characteristics.

Quality Assessment of Included Studies

The quality of the included studies was assessed in duplicate by two independent reviewers using the Methodological Index for Non-Randomized Studies (MINORS) instrument [23]. The MINORS score is a validated tool specifically designed to assess the reporting quality of non-randomized surgical studies, including both comparative and non-comparative studies. A score of 0–4 indicates very low quality evidence, 5–7 indicates low quality, 8–12 indicates fair quality and scores of 13 or greater indicate high quality evidence. The maximum score for a non-comparative study is 16, and 24 for a comparative study.

Statistical Analysis

Descriptive statistics including means, standard deviations, ranges and proportions were presented where applicable. Meta-analysis was unable to be reported due to the heterogeneity of outcomes reported. Cohen’s kappa was used to evaluate agreement between assessors during the screening phase. Intra-class correlation coefficient (ICC) was used to evaluate agreement between assessors in quality assessment of included studies.

Results

Characteristics of Included Studies

A total of 59 studies (53913 patients) were identified as meeting the inclusion criteria. Cohen’s kappa was 0.707 following title and abstract screening and 0.787 following full-text screening, indicating substantial agreement between assessors. There was 1 randomized controlled trial in female athletes [24], 4 case control studies [25–28], 17 prospective cohort studies [29–45], 29 retrospective cohort studies [46–72], 7 case series [73–79] and 1 qualitative study [80] included in the review. There were 34 studies (58%) which included females only, whereas 25 studies compared male and female athletes (42%). All included studies focused on sex, and none of the studies considered gender or reported data on non-binary individuals. Based on the MINORS criteria, four of the included studies were of fair quality evidence and the remaining 54 studies were of high quality evidence (Table 1). Inter-rater agreement on the MINORS quality assessment was high, with an ICC of 0.818 (95% CI 0.692–0.895).

Table 1.

Characteristics of included studies

Author	Year	Country	Level of evidence	Sex/ gender comparison	Injury/ surgery	Sample size	% female
Lei et al.	2024	Korea	I	Female only	RCR	124	100%
Ben et al.	2024	Korea	II	Male vs. female	RCR	83	57%
Mausehund Krosshaug	2024	Norway	II	Female only	ACL rupture	756	100%
Hartman et al.	2024	USA	III	Male vs. female	Achilles tendon rupture	863	18%
Shankar et al.	2024	USA	III	Female only	FAI	103	100%
Zarzycki et al.	2024	USA	III	Female only	ACL rupture	39	100%
Zeng et al.	2024	Singapore	III	Male vs. female	RCR	266	56%
Ferrer-Rivero et al.	2024	Spain	IV	Female only	FAI	33	100%
Gerard et al.	2024	USA	IV	Female only	UCL repair	15	100%
Shibahashi et al.	2024	Japan	IV	Male vs. female	RCR	124	34%
Faltstrom et al.	2023	Sweden	II	Female only	ACL rupture	186	100%
Gianakos et al.	2023	USA	III	Male vs. female	OLT	69	45%
Gianakos et al.	2023	USA	III	Male vs. female	OLT	87	36%
Giordano et al.	2023	Italy	III	Female only	ACL rupture	489	100%
Lee et al.	2023	Korea	III	Female only	ACL rupture	78	100%
Li et al.	2023	Switzerland	III	Female only	Hip arthroscopy	85	100%
Pasqualini et al.	2023	USA	III	Male vs. female	Anterior shoulder instability	164	35%
Pichler et al.	2023	Austria	III	Male vs. female	ACL rupture	54	50%
Haley et al.	2023	USA	IIII	Male vs. female	ACL rupture	721	42%
Marland et al.	2023	USA	IV	Female only	FAI	243	100%
Ezzat et al.	2022	Canada	II	Female only	ACL rupture	102	100%
Lee et al.	2022	Korea	II	Female only	RCR	30	100%
Frank et al.	2022	USA	III	Male vs. female	Meniscal allograft transplantation	212	50%
Jimenez et al.	2022	USA	III	Female only	FAI	22	100%
Maempel et al.	2022	UK	III	Male vs. female	Achilles tendon rupture	783	28%
Marland et al.	2022	USA	III	Female only	FAI	249	100%
Oguzkaya et al.	2022	Turkey	III	Female only	RCR	55	100%
Owens et al.	2022	USA	III	Male vs. female	FAI	65	100%
Rudisill et al.	2022	USA	III	Male vs. female	RCR	42,443	42%
Goto et al.	2022	Switzerland	IV	Female only	ACL rupture	73	100%
Ezzat et al.	2021	Canada	II	Female only	ACL rupture	102	100%
Faltstrom et al.	2021	Sweden	II	Female only	ACL rupture	117	100%
Faltstrom et al.	2021	Sweden	II	Female only	ACL rupture	222	100%
Maerz et al.	2021	USA	II	Male vs. female	FAI	621	57%
Sabo et al.	2021	Canada	II	Male vs. female	RCR	148	51%
Beck et al.	2021	USA	III	Male vs. female	FAI	150	50%
Chen et al.	2021	China	III	Male vs. female	Anterior shoulder instability	76	20%
Glein et al.	2021	USA	III	Male vs. female	FAI	73	100%
Kostyun et al.	2021	USA	III	Male vs. female	ACL rupture	93	55%
Lowenstein et al.	2021	USA	III	Male vs. female	ACL rupture	100	62%
Maldonado et al.	2021	USA	III	Female only	FAI	74	100%
Raymond-Pope et al.	2021	USA	III	Female only	ACL rupture	24	100%
Saks et al.	2021	USA	III	Male vs. female	FAI	317	34%
Wilson et al.	2021	USA	III	Female only	Elbow overuse injuries (Radial head stress fracture, capitellum OCD)	58	100%
Flores et al.	2020	USA	III	Male vs. female	Hip arthroscopy	131	55%
Bloom et al.	2020	USA	IV	Female only	FAI	194	100%
Lisee et al.	2020	USA	IV	Male vs. female	ACL rupture	25	52%
Moore et al.	2020	Ireland	IV	Female only	Anterior shoulder instability	31	100%
Brumitt, et al.	2019	USA	II	Female only	ACL rupture	360	100%
Faltstrom et al.	2019	Sweden	II	Female only	ACL rupture	236	100%
Magnuson et al.	2019	USA	II	Male vs. female	Shoulder instability	1010	19%
Bourne et al.	2019	Australia	III	Female only	Anterior cruciate ligament (ACL) rupture	84	100%
Christensen et al.	2019	USA	III	Female only	FAI	173	100%
Daniels et al.	2019	USA	III	Male vs. female	RCR	283	46%
Davey et al.	2019	USA	III	Female only	ACL rupture	55	100%
Frank et al.	2019	USA	III	Female only	FAI	330	100%
Salem et al.	2019	USA	III	Female only	ACL rupture	256	100%
Wrzesie et al.	2019	Poland	III	Female only	ACL rupture	20	100%
Patzkowski et al.	2019	USA	IV	Female only	Shoulder instability	36	100%

RCR: rotator cuff repair; ACL: anterior cruciate ligament; FAI: femoracetabular impingement; UCL: ulnar collateral ligament, OLT: osteochondral lesions of the talus

ACL Injury & Reconstruction

There were 22 studies (4156 patients) evaluating ACL injuries [25, 28, 31, 32, 34–36, 38–40, 44, 49, 54, 56, 59, 60, 64, 67, 69, 72, 81]. 3372 (81%) patients were female and 17/22 studies exclusively included female athletes. Female athletes post-ACL reconstruction had lower levels of physical activity compared to their pre-ACL injury levels and compared to female athletes who never had an ACL injury [35, 39]. Return to sport levels varied, with one studying reporting that 67.2% of female athletes returned to pre-injury level sport following ACL reconstruction, compared to another reporting that 62% of female athletes quit playing soccer following ACL reconstruction [39, 67].

Nine studies investigated the risk of recurrent ACL injury in female athletes, but none assessed how sex differences may impact the risk of recurrent ACL injury. All four studies, which compared risk of ACL injury in female athletes with a prior ACL reconstruction to matched controls with no history of ACL injury, showed an increased risk of ACL injury in those with a previous injury, ranging from 4 to 7 times higher risk [34, 36, 39, 40]. Factors associated with recurrent ACL injury included use of a hamstrings tendon graft in reconstruction, return to soccer, younger age, higher number of hours per week spent in sport, 5 jump test result < 916 cm, Swedish Universities Scales of Personality (SSP) stress susceptibility scores > 44.4 and adventure seeking scores > 53.2, difference in ankle dorsiflexion range of motion of -2.5° compared to contralateral healthy leg, ACL-RSI score > 5.8, limb symmetry index side hop > 96.9% and single hop > 102% [32, 37, 40, 49, 67],.

Four studies assessed psychological readiness to return to sport following ACL reconstruction, using the Anterior Cruciate Ligament Return to Sport After Injury Survey (ACL-RSI). Two studies compared ACL-RSI between male and female athletes with contrasting results. In a study of 93 patients, Kostyun et al. showed a significant main effect for sex (p = 0.01) with male athletes having higher ACL-RSI scores at preoperative, 3 months postoperative and the return to sport phase of rehabilitation [31]. Conversely, Lisee et al. did not show a difference in ACL-RSI scores between male and female athletes (74.9±19.7 vs. 77.6±10.8, p = 0.66) in a study of 25 patients at an average of 6 months postoperatively [80]. A qualitative study illustrated mood changes in both female and male athletes following ACL reconstruction surgery, including frustration and sadness [80]. Male athletes expressed more fear regarding sport specific movements, such as landing or cutting, whereas female athletes expressed more fear regarding activities of daily living and general forms of physical activity. Among female patients, there was no difference in ACL-RSI between patients who had undergone a second ACL injury and those who had not [32], or between normal and short statured patients [72].

Femoracetabular Impingement & Hip Arthroscopy

Femoracetabular impingement and hip arthroscopy were assessed in 16 studies which included a total of 2863 patients, 2252 (80%) of whom were female [26, 27, 29, 30, 42, 47, 51, 55, 58, 62, 66, 68, 71, 73, 75, 76]. Six studies including 1357 patients compared patient reported outcome measures (PROMS) following hip arthroscopy between men and women between 2 and 5 years postoperatively [29, 30, 42, 55, 62, 66]. All studies showed an improvement in PROMS following hip arthroscopy in male and female athletes, with no significant sex differences reported. Return to sport rates were assessed in three studies which ranged from 75 to 80% amongst female athletes who underwent hip arthroscopy [55, 58, 62]. There was no significant difference in return to sport rates between female and male athletes [55], or between normal and low BMI female athletes [58]. Four studies assessed individuals with hip dysplasia [26, 47, 66, 76]. Saks et al. compared the postoperative outcomes of male and female patients with borderline hip dysplasia who underwent hip arthroscopy, showing improvements in both with no significant difference between groups [66]. Two studies showed lower improvements in international hip outcome tool (i-HOT) scores in patients with dysplastic acetabula compared to those with normal acetabular morphology, though both groups did significantly improve from baseline [47, 76]. One study assessed perceived risks of hip arthroscopy on pregnancy among reproductive aged women [75]. Half of all subjects expressed “some” to “a lot of” concern that their hip pain could worsen during pregnancy (49.4%), and about half had “no concern” that hip arthroscopy would affect the health of their fetus/baby (54.1%).

Rotator Cuff Rupture & Repair

Nine studies including 43,616 individuals, 18,673 (43%) of which were female, evaluated outcomes following rotator cuff injuries and repairs [24, 33, 41, 45, 48, 65, 70, 79, 82]. Six of the nine studies performed sex-based comparisons [33, 45, 48, 65, 70, 79]. A retrospective cohort study which assessed perioperative outcomes of arthroscopic rotator cuff repair accounted for 97% of the included participants [65]. Female patients were found to have higher rates of minor adverse events than males (OR = 1.75 (95% CI 1.24–2.47), p = 0.001), but were less likely to experience major adverse events (OR = 0.69 (95% CI 0.55–0.85), p = 0.001) or hospital readmission (OR = 0.80 (95% CI 0.66–0.97), p = 0.001). In four studies, women had higher VAS pain scores than men at preoperative and postoperative assessments [41, 48, 70, 79]. PROMS varied amongst studies, with two studies showing greater improvements in functional outcomes in male compared to female athletes [70, 79] and three studies showing no difference between sexes [33, 45, 48]. Oguzkaya and colleagues assessed the impact of age in female patients undergoing rotator cuff repair, showing no difference in clinical or functional outcomes between patients younger and older than 60 years of age [82]. Finally, a randomized controlled trial investigating the effect of zoledronic acid on rotator cuff tendon healing in female patients showed higher radiographic tendon healing, but no difference in functional outcomes at 2 years postoperatively [24].

Other Injuries

The remaining studies investigated a variety of sports injuries in female athletes including shoulder instability (5), talus osteochondral defects (2), Achilles tendon ruptures (2), meniscal injuries (1), stress fractures (1), ulnar collateral ligament (UCL) injury (1). There were no differences seen in postoperative PROMS or recurrence rate between male and female participants who underwent anterior shoulder stabilization [43, 46, 63].

Discussion

The main finding of this 59-study review is that the current evidence in the treatment and outcomes of sports injuries among female athletes focuses on sex-based differences, with no consideration or evaluation of the impact of gender. Sex-related differences were seen in readiness to return to sport following ACL injury, mood changes related to ACL injury, and VAS pain scores in patients undergoing rotator cuff repairs. The included studies also found that female athletes who experienced an ACL reconstruction have lower levels of activity than pre-ACL rupture and are at 4–7 times greater risk of sustaining another ACL injury.

Many of the sex-related differences that were seen in this review were related to subjective patient experience, which indicates that male and female athletes experience injury differently. Some key findings from this study include that male and female athletes experienced different fears regarding ACL injuries, female athletes had specific concerns regarding pregnancy after hip arthroscopy, and female patients had higher VAS pain scores preoperatively and postoperatively following rotator cuff repair. These examples illustrate that important differences exist between male and female athletes in their injury experience, despite the lack of physiologic rationale for sex-related differences in these outcomes. Scolnik and colleagues explain differences in sport experiences between male and female athletes as being influenced by an individuals’ athletic identity [16]. Athletic identity refers to the degree to which an individual identifies with the athlete role, or is dedicated to sport relative to other aspects of one’s life [15].

The presence of a sports injury can significantly influence one’s athletic identity, and conversely, one’s athletic identity can impact an individual’s sport injury experience. For example, in a study of 16–18-year-old male and female athletes, higher athletic identity was positively correlated with depressive symptoms following a sport-related injury [83]. The role of athletic identity is especially important when considering the injury experiences of non-binary and transgender athletes. Existing literature outlines primarily negative experiences of non-binary and transgender individuals when participating in sport due to prejudice, transphobia and maltreatment, which significantly impacts their athletic identity [84]. Since athletic identity is more closely related to gender rather than sex, gender is more likely to influence injury experience than sex. For this reason, it is critical that future research evaluate gender-based differences in sports injuries.

While a comprehensive search strategy was used, most of the included studies focused primarily on 3 sports injuries: ACL injury, femoracetabular impingement and labral tear, and rotator cuff injuries. While these are amongst the most common sports injuries, it illustrates the lack of comprehensive understanding that exists across all sports injuries in female and non-binary athletes. To provide optimal clinical care to all patients, it is important that the experiences of all athletes with all injuries are characterized in the literature, to allow for the identification of any differences. Over the past decade, there has been a substantial focus on sex-related differences in ACL injuries which has significantly impacted the care of ACL injuries in female athletes, including the development of prevention strategies [85]. By deepening the understanding of sex- and gender-related differences in all sports injuries, there is potential to improve the injury prevention strategies, diagnosis and treatment for all athletes.

This study is novel in its approach to assessing gender-based differences in sports injuries. As a systematic review which focused on studies published within the past 5 years, it was able to characterize the current state of the literature in sports injuries in female and non-binary athletes. It is strengthened by its rigorous methodology including a comprehensive search and data extraction strategy. Reviewer bias was minimized by independently completing each stage of the process in duplicate. All eligible studies were included regardless of missing data. This study was limited by the qualitative nature of the review, as statistical comparisons were not able to be performed.

Conclusions

Despite increasing recognition of the role of sex in the treatment and outcomes of sports injuries, none of the current literature assesses the impact of gender. Over half of the studies in this review included only female patients, which emphasizes the increasing recognition of the importance of characterizing the experiences of female athletes. However, the injury focus of these studies is quite limited, and the experiences of non-binary and transgender athletes remain understudied. Future research should aim to characterize the effect of gender on the treatment and outcomes on all sports injuries, with the goal of providing inclusive sports medicine care for all athletes.

Key References

1. Ezzat AM, Brussoni M, Mâsse LC, Emery CA. Effect of Anterior Cruciate Ligament Rupture on Physical Activity, Sports Participation, Patient-Reported Health Outcomes, and Physical Function in Young Female Athletes. The American journal of sports medicine. 2021;49 [6]:1460–9.

   A recent prospective cohort study including over 100 patients showing that female athletes have lower levels of physical activity following an ACL reconstruction.

2. Kostyun RO, Burland JP, Kostyun KJ, Milewski MD, Nissen CW. Male and Female Adolescent Athletes’ Readiness to Return to Sport After Anterior Cruciate Ligament Injury and Reconstruction. Clinical Journal of Sport Medicine. 2021;31 [4]:383–7.

   A recent prospective cohort study comparing 51 female and 42 male athletes which shows a sex-related difference in readiness to return to sport at multiple postoperative time points.

3. Beck E.C., Drager J., Nwachukwu B.U., Jan K., Rasio J., Nho S.J. AO - Jan K, et al. Gender and Age-Specific Differences Observed in Rates of Achieving Meaningful Clinical Outcomes 5-Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2021;37 [8]:2488–96.

   A prospective cohort study of 175 patients who underwent hip arthroscopy which showed no sex-related differences in longterm outcomes.

4. Li Z., Triana J., Lan R., Eskenazi J., Hughes A., Youm T., et al. The Impact of Hip Arthroscopy on Pregnancy-Related Decision-Making and Outcomes among Female Patients: A Single Surgeon’s Experience. Orthopaedic Journal of Sports Medicine. 2023;11 [7].

   A case series of female patients assessing pregnancy related concerns related to hip pain and hip arthroscopy.

5. Rudisill S.S., Eberlin C.T., Kucharik M.P., Linker J.A., Naessig S.A., Best M.J., et al. Sex differences in utilization and perioperative outcomes of arthroscopic rotator cuff repair. JSES International. 2022;6 [6]:992–8.

   A large retrospective cohort study including over 40000 patients undergoing rotator cuff repair which showed that female patients had higher rates of minor adverse events than males but were less likely to experience major adverse events or hospital readmission.

Appendix 1: Search terms

1. Sport injur$.

2. Arthroscop$.

3. Athletic injur$.

4. Female.ti.

5. Non-binary.ti.

6. Sex.ti.

7. Gender.ti.

8. 1 OR 2 OR 3.

9. 4 OR 5 OR 6 OR 7.

10. 8 AND 9.

11. Limit 10 to English language.

12. Limit 11 to human.

13. Limit 12 to 2014 – present.

Author Contributions

LN developed the methods and prepared the manuscript. LM and AA performed screening of titles and abstracts and full-text for inclusion in the review. All screening conflicts were resolved by LAG. LAG, NS, KM, MS and OA contributed significantly to the development of the methods and drafting of the manuscript. All authors reviewed the final manuscript.

Funding

No funding was received.

Data Availability

No datasets were generated or analysed during the current study.

Declarations

Competing Interests

The authors declare no competing interests.